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Introduction: The aim of the study was to investigate whether robotic‐assisted surgery is associated with lower incremental resource use among obese patients relative to non‐obese patients after a Danish nationwide adoption of robotic‐assisted surgery in women with early‐stage endometrial cancer. This is a population‐based cohort study based on registers and clinical data. Material and methods: All women who underwent surgery (robotic, laparoscopic and laparotomy) from 2008 to 2015 were included and divided according to body mass index (<30 and ≥30). Robotic‐assisted surgery was gradually introduced in Denmark (2008–2013). We compared resource use post‐surgery in obese vs non‐obese women who underwent surgery before and after a nationwide adoption of robotic‐assisted surgery. The key exposure variable was exposure to robotic‐assisted surgery. Clinical and sociodemographic data were linked with national register data to determine costs and bed days 12 months before and after surgery applying difference‐in‐difference analyses. Results: In total, 3934 women were included. The adoption of robotic‐assisted surgery did not demonstrate statistically significant implications for total costs among obese women (€3,417; 95% confidence interval [CI] −€854 to €7,688, p = 0.117). Further, for obese women, a statistically significant reduction in bed days related to the index hospitalization was demonstrated (−1.9 bed days; 95% CI −3.6 to −0.2, p = 0.025). However, for non‐obese women, the adoption of robotic‐assisted surgery was associated with statistically significant total costs increments of €9,333 (95% CI €3,729–€1,4936, p = 0.001) and no reduction in bed days related to the index hospitalization was observed (+0.9 bed days; 95% CI −0.6 to 2.3, p = 0.242). Conclusions: The national investment in robotic‐assisted surgery for endometrial cancer seems to have more modest cost implications post‐surgery for obese women. This may be partly driven by a significant reduction in bed days related to the index hospitalization among obese women, as well as reductions in subsequent hospitalizations. [ABSTRACT FROM AUTHOR]

Sustainable and informed resource consumption is the key to make everyday living sustainable for entire populations. An intelligent and strategic way of addressing the challenges related with sustainable development of the everyday living of consumers is to identify consumption-determined hotspots in terms of environmental and health burdens, as well as resource consumptions. Analyzing consumer life styles in terms of consumption patterns in order to identify hotspots is hence the focus of this study. This is achieved by taking into account the entire value chain of the commodities consumed in the context of environmental and human health burdens, as well as resource consumptions. A systematic commodity consumption, commodity disposal, and life style survey of 1281 persons living in urbanized Danish areas was conducted. The findings of the survey showed new impact dimensions in terms of Personal Metabolism (PM) patterns of residents living in urbanized areas of Denmark. Extending the PM analysis with Life Cycle Assessment (LCA) provided a clear picture of the per capita environmental and human health burdens, as well as resource consumptions, and the exact origin hereof. A generic PM-LCA Model for all the 1281 persons was set-up in Gabi 6. The assessment results obtained applying the model on all 1281 personal consumption scenarios yielded the 1281 Personal Impact Profiles (PIPs). Consumption of food and energy (electricity and thermal energy) proved to be the primary impact sources of PM, followed by transport. The PIPs further revealed that behavioral factors ( e.g. different diets, use of cars, household size) affect the profiles. Hence, behavioral changes are one means out of many that humanity will most likely have to rely on during the sustainable development process. The results of this study will help the Danish and other comparable populations to identify and prioritize the steps towards reducing their environmental, human health, and resource consumption burdens. [ABSTRACT FROM AUTHOR]

Objective: The majority of cost-studies related to robotic surgery has a short follow-up and primarily report the costs from the index surgery. The aim of this study was to evaluate the long-term resource consequences of introducing robotic surgery for early stage endometrial cancer in Denmark., Methods: The study included all women with early stage endometrial cancer who underwent robotic, laparoscopic and open access surgery from January 2008 to June 2015. Data was linked from national databases to determine resource consumption and costs from hospital treatments, outpatient contacts, primary health care sector visits, labor market affiliation and prescription of medication. Each patient was observed in a period of 12 months before- and after surgery. The key exposure variable was women who were exposed to robotic surgery compared to those who were not., Results: A total of 4133 women underwent surgery for early stage endometrial cancer. The study found additional costs of $7309 (95% confidence interval [CI] 2100-11,620, P = 0.001) per patient in the group exposed to robotic surgery including long-term costs post-surgery compared to the non-exposed group (non-robotic group). When controlling for time trends, the introduction of robotic surgery did not reduce the number of bed days (mean diff -0.42, 95% CI -3.03-2.19, P = 0.752)., Conclusions: The introduction of robotic surgery for early stage endometrial cancer did not generate any long-term cost savings. The additional costs of robotic surgery were primarily driven by the index surgery. Any reduction in bed days could be explained by time trends., (Copyright © 2019 Elsevier Inc. All rights reserved.)