Uptake and outcomes of robotic gynaecological surgery in England (2006–2018): an account of Hospital Episodes Statistics (HES)

Abstract

This was a retrospective study to review the uptake and outcomes of robotic gynaecological surgery in England between 1st April 2006 and 31st March 2018, analysing Hospital Episode Statistics form National Health Service hospitals in England. Women aged 18 years and above who had elective gynaecological surgery were included and those who had undergone robotic gynaecology surgery were included. Robotic gynaecological procedures were defined as procedures that used a robotic minimal access approach for hysterectomy, adnexal surgery and urogynaecological surgery (sacrocolpopexy, sacrohysteropexy and colposuspension). Numbers of procedures were reviewed by year and mapped to the 44 NHS healthcare regions. Length of stay (nights in hospital), laparotomy (conversion during primary procedure or after return to theatre for management of complication), and 30-day emergency readmission rates were calculated by year and procedure type. Overall 527,217 elective gynaecological procedures were performed in the English NHS (1st April 2006 and 31st March 2018), of which 4384 (0.83%) were performed with robotic assistance (3864 (88%) hysterectomy, 706 (16%) adnexal surgery, 192 (4%) urogynaecological surgery). There was gradual rise in the uptake of robotic surgery but there was a marked geographical variation. Median (IQR) length of stay (LOS) was 1(1–2) night, laparotomy rate was 0.3% and 30-day emergency readmission rate was 4.7%. LOS was statistically, but not clinically, different across time. Other outcomes did not differ by year. Robotic gynaecological procedures are increasingly being used in the English NHS, predominantly for hysterectomy, although in small proportions (2.6% in the most recent study year). There was wide geographical variation in robotic uptake across England and overall, outcomes were comparable to those reported in other countries.

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Data availability

Study data and material are available and could be shared if needed following appropriate approvals.

Code availability

OPCS-4 surgical procedure codes used in the study are included in the supplementary material. OPCS-4.8 is a publically available document and is appropriately referenced in text.

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Funding

This study was supported by a grant from the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme (14/70/162). The funder was not involved in conducting the research or writing this paper.

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Authors

Contributions

The study was conceived and designed by all authors. RSG and IGU organised the datasets and performed the statistical analysis, DEH wrote the first draft of the manuscript; DEH and IGU wrote the final manuscript, with input from JvdM and DGT. All authors approved the final text.

Corresponding author

Correspondence to D. Tincello.

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Conflict of interest

DGT acted as consultant for Cambridge Medical Robotics Surgical (CMR-surgical), but was not involved in data extraction or analysis. All other authors have no conflicts of interest to disclose.

Ethics approval

The use of Hospital Episode Statistics data for the purpose evaluations of care delivered by the NHS was approved by the Confidentiality Advisory Group of the NHS Health Research Authority (15/CAG/0148).

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The data are anonymised and, therefore, their use does not require ethical approval and individual-level patient consent.

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The data are anonymised and, therefore, their use does not require ethical approval and individual-level patient consent.

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Cite this article

El-Hamamsy, D., Geary, R.S., Gurol-Urganci, I. et al. Uptake and outcomes of robotic gynaecological surgery in England (2006–2018): an account of Hospital Episodes Statistics (HES). J Robotic Surg (2021). https://doi.org/10.1007/s11701-021-01197-5

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Keywords

  • Robotic
  • Gynaecological
  • Surgery
  • Hospital episodes statistics (HES)