The value of uterine oncological surgery in a University Hospital. Results of a break-even analysis

Abstract Background Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital. Methods An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated. Results 1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus 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-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06). Conclusions The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital. Key messages • The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery. • The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.


Background:
Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability.This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital.Methods: An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery.DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery.Student's t and Chi-square tests were used to assess differences and the break-even point was calculated.Results: 1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery.Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 E;95%CI: -1240.44 --897.92E) mainly due to devices cost (3549.37E; 95%CI: 3459.32E -3639.43E), and a lower 30-days readmissions percentage (1.4%;95%CI: 0.2% -2.6%) with a significant difference only versus laparotomy (p = 0.029).Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21E; 95%CI: 1531.75E -1852.66E) without a significant difference for 30-days readmissions.The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 -2.06).

Conclusions:
The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries' volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital.

Key messages:
The value-based healthcare approach, defined as the measured improvement in a patient's health outcomes in relation to its cost, finds effective application in uterine cancer surgery.The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.
Abstract citation ID: ckac131.286Determinants of regulatory compliance in health and social care services: a systematic review

Background:
The delivery of high quality health and social care services is a fundamental goal for health systems worldwide.Quality is variable in services and settings.One response to variation in quality is a regulatory framework that looks to set minimum standards that are enforced by an independent public authority.This systematic review seeks to identify and describe determinants of regulatory compliance in health and social care services.

Methods:
Systematic searches were carried out on five electronic databases and grey literature sources.Titles and abstracts were screened by two reviewers independently.Determinants evaluated in studies were identified, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR).The included studies were quality appraised by two reviewers independently.The results were synthesised narratively under each CFIR domain.

Results:
The search yielded 6,515 articles for screening, of which 148 were included.Most studies were quantitative designs focused on specific exposures (e.g.staffing levels, size, for-profit status).Qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance.Most of the determinants identified fit within the inner and outer setting domains of the CFIR, many with mixed findings in terms of an association with compliance.There were fewer determinants identified in the intervention characteristics, characteristics of individuals, and process domains of the CFIR.

Conclusions:
The literature in this field focuses on the broader concept of quality and appears to neglect the more nuanced issues