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Robotic-assisted hysterectomy for benign gynecologic disease in the United States: in-hospital use of opioid and non-opioid analgesics

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Abstract

To compare the in-hospital opioid and non-opioid analgesic use among women who underwent robotic-assisted hysterectomy (RH) vs. open (OH), vaginal (VH), or laparoscopic hysterectomy (LH). Records of women in the United States who underwent hysterectomy for benign gynecologic disease were extracted from the Premier Healthcare Database (2013–2019). Propensity score methods were used to create three 1:1 matched cohorts stratified in inpatients [RH vs. OH (N = 16,821 pairs), RH vs. VH (N = 6149), RH vs. LH (N = 11,250)] and outpatients [RH vs. OH (N = 3139), RH vs. VH (N = 29,954), RH vs. LH (N = 85,040)]. Opioid doses were converted to morphine milligram equivalents (MME). Within matched cohorts, opioid and non-opioid analgesic use was compared. On the day of surgery, the percentage of patients who received opioids differed only for outpatients who underwent RH vs. LH or VH (maximum difference = 1%; p < 0.001). RH was associated with lower total doses of opioids in all matched cohorts (each p < 0.001), with the largest difference observed between RH and OH: median (IQR) of 47.5 (25.0–90.0) vs. 82.5 (36.0–137.0) MME among inpatients and 39.3 (19.5–66.0) vs. 60.0 (35.0–113.3) among outpatients. After the day of surgery, fewer inpatients who underwent RH received opioids vs. OH (78.7 vs. 87.5%; p < 0.001) or LH (78.6 vs. 80.6%; p < 0.001). The median MME was lower for RH (15.0; 7.5–33.5) versus OH (22.5; 15.0–55.0; p < 0.001). Minor differences were observed for non-opioid analgesics. RH was associated with lower in-hospital opioid use than OH, whereas the same magnitude of difference was not observed for RH vs. LH or VH.

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Data availability

The data that support the findings of this study are from the Premier Healthcare Database, a commercially available database for purchase.

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Funding

The study was funded by the Intuitive Foundation as a Clinical Robotic Research Grant. The funder was not involved in any step of the study protocol writing, research and statistical analysis conduction, results interpretation, or manuscript writing. The content of the present manuscript is the expression of the work and sole opinion of the authors.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Simone Garzon, Andrea Mariani, Sean C. Dowdy, Carrie L. Langstraat & Gretchen E. Glaser

  2. Unit of Gynecology and Obstetrics, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy

    Simone Garzon & Stefano Uccella

  3. Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA

    Amy L. Weaver & Michaela E. Mcgree

  4. Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy

    Fabio Ghezzi

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  1. Simone Garzon
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  2. Andrea Mariani
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  8. Carrie L. Langstraat
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  9. Gretchen E. Glaser
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Contributions

Conceived and designed the study: SG, AM, ALW, GEG; Data collection, analysis, and interpretation: ALW, MEM, SG, AM, SCD, GEG; Writing, review, and editing: SG, AM, ALW, GEG, MEM, SCD, SU, FG, CLL.

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Correspondence to Gretchen E. Glaser.

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The Institutional Review Board of Mayo Clinic approved the retrospective study design with anonymized handling of the data (20-007945).

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Garzon, S., Mariani, A., Weaver, A.L. et al. Robotic-assisted hysterectomy for benign gynecologic disease in the United States: in-hospital use of opioid and non-opioid analgesics. J Robotic Surg 18, 182 (2024). https://doi.org/10.1007/s11701-024-01948-0

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