The value of surgical admissions for malignant uterine cancer. A comparative analysis of robotic, laparoscopic, and laparotomy surgery in a university hospital.

Background: Robotic surgery for malignant uterine cancer raises issue of economic sustainability for providers. The objective of this study was to assess the value of surgical admissions for malignant uterine cancer in a University Hospital through an analysis of their costs and outcomes by comparing three different surgical approaches (laparotomy, laparoscopic, and robotic surgery). Methods: Hospitalizations between 1 January 2019 and 31 October 2021 for malignant uterine cancer surgery were selected and stratified. For each surgical approach, mean values (with 95% confidence intervals, CI) were calculated for cost items. Moreover, 30-day readmission frequency was calculated for the three approaches compared to each other. ANOVA and Student's t-test and relative risk (RR) were used for statistical analysis. A break-even analysis was carried out by evaluating the volume of robotic and non-robotic surgical admissions. Results: A total of 1,336 hospitalizations were included in the study, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery, compared to laparoscopic and laparotomy ones, showed a statistically significant difference (p < 0.001) in the economic margin, which was largely negative (-1069.18 €; 95%CI:-1240.44--897.92 €) mainly due to devices cost, and a lower percentage of 30-day readmissions (1.4%; 95%CI: 0.2-2.6%), with a statistically significant difference only vs. laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 €-1852.66 €) without a significant difference for 30-day readmissions. Break-even analysis showed that, on average, for each malignant uterine cancer elective surgery performed laparoscopically, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23-2.06). Conclusion: Break-even analysis could be a useful tool to support hospital management in planning and governance of malignant uterine cancer surgery. Systematic application of this tool will allow defining over time right distribution of robotic, laparoscopic, and laparotomy surgeries' volumes to perform to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery. Concerning research, this study paves the way for a multicentric study, the extension of outcomes of malignant uterine surgery to be considered and assessed, and the future inclusion of other therapeutic interventions in the analysis.

[Evaluation of hospital admissions for angiocardiographic procedures in patients with cardiovascular disease (DRG 124): a retrospective study in four Rome hospitals (Italy)]. / Analisi dei ricoveri ordinari finalizzati all'esecuzione di esami angiocardiografici per patologie cardiovascolari attributi al DRG 124: studio retrospettivo in quattro ospedali di Roma.

The aim of this study was to evaluate hospital admissions assigned to DRG 124 because attributable to the diagnosis and therapy of cardiovascular diseases and the performance of an angiocardiographic exam with contrast and/or cardiac catheterism. As part of the hospital activity evaluations performed by the Lazio Region between 1 January 2002 and 30 June 2005 in four healthcare institutions in the Rome metropolitan area, 136 admissions assigned to DRG 124 were evaluated. An evaluation grid was used to verify information recorded in the hospital discharge forms and hospital medical records for these admissions. Overall 89% (121/136) of medical records were found to be incongruent with the corresponding hospital discharge form and 53% of admissions (72/136) were reassigned a different DRG after evaluation. In most of these cases (n=54; 76%) the selection of a different DRG was required because an incorrect main diagnosis had originally been chosen. The mean relative weight of admissions in which DRG reassignment was required was 1.4189 before recoding and 0.7545 after these were assigned to a new DRG.

[A retrospective study to evaluate the quality of medical charts and discharge abstracts in several Rome hospitals]. / Qualità della cartella clinica e della scheda di dimissione ospedaliera: studio retrospettivo in alcuni ospedali di Roma.

Previous studies have shown that the quality of medical records is not uniform across Italian hospitals. Between March 2002 and January 2003, we assessed the quality of 6,215 medical charts regarding admissions to 11 different Rome hospitals in the year 2001. The hospitals were located within the territory of the ROMA "A" and ROMA "C" Local Health Units. The following were evaluated: 1) organization, format and lay-out of medical records; 2) medical chart and discharge abstract compilation; 3) ICD-9-CM coding accuracy. The quality of medical records and of discharge abstracts, as judged especially by their format and by the completeness, accuracy, congruency and clearness of the reported information, varied extensively among the different wards and hospitals. The main problems were identified and possible solutions are discussed. We suggest that improved quality of medical records and discharge abstracts may be promoted through: 1) use of a standardized format for medical records in all wards of the same hospital; a supplement may eventually account for the characteristic requirements of specialist wards; 2) adoption of guidelines for medical record-keeping and of a code of conduct for discharge abstract coders; 3) use of a new discharge abstract form that favours more accurate ICD-9-CM coding and that allows more effective gathering of clinical data for epidemiological purposes.