Hysterectomy costs depending on operational technique

Abstract

Objectives:The aim of the study was to perform a comparative analysis of hysterectomy costs versus the operative technique based on the data of 656 patients operated at the Department of Obstetrics and Gynecology with Gynecological Oncology Subdivision, Brothers Hospitallers of Saint John of God Hospital, Katowice, between 2016and 2018 (until May 31, 2018. Material and methods:This retrospective research involved 656 patients who underwent hysterectomy for non-oncological reasons. The patients were subdivided into three groups, depending on the operative method (transabdominal, laparoscopic or transvaginal). Next, treatment costs were compared, including the costs of hospitalization, operating block, operating block materials, drugs, anesthesia, and medical staff. The duration of the operation and the hospital stay were also analyzed as they significantly affected the final result.Results: Data analysis revealed that transvaginal hysterectomy generated the lowest costs. A positive relationship between low costs and the duration of surgery and hospitalization, which is significantly shortened in case of transvaginal hysterectomy, was confirmed. Conclusions:1. The transvaginal approach is the most cost-effective technique of hysterectomy. 2. Apart from the financial advantage, transvaginal hysterectomy is also associated with shorter hospitalization and faster recovery. 3. Emphasis should be placed on training physicians in minimally invasive hysterectomies -especially the transvaginal approach -so that the greatest percentage of patients who are deemed eligible for hysterectomy could be operated using this minimally invasive technique.

Healthcare and Indirect Cost of the Laparoscopic vs. Vaginal Approach in Benign Hysterectomy

“…Although indirect costs are relevant and must be taken into account if we want to know the real cost, most comparative studies are conducted incorporating only hospitalization costs associated with each procedure. 8,16,17 This study carries out a cost analysis of both healthcare costs and indirect costs over five years.…”

“…Currently in gynecological surgery, it is recommended to use vaginal hysterectomy when feasible, for benign pathology. [1][2][3][4][5][6][7][8][9] Total laparoscopic hysterectomy (LH) is a technique with a longer learning curve but with minimally invasive surgery advantages including reduced invasiveness, shorter hospital stay, faster postoperative recovery, greater precision of surgical maneuvers, and less blood loss. 10 It also provides a better vision of anatomical spaces, permits the surgeon to perform simultaneous pelvic and abdominal surgeries, and allows the surgeon to operate large and nonprolapsed uteri.…”

“…2,3,15 To our knowledge, this study represents the most expansive analysis of costs associated with LH and VH for benign disease. Most comparative studies on hysterectomy are based on hospitalization cost 8,16,17 and the most important contribution of this study is the consideration of the indirect cost mainly represented by transport and lostwork-productivity costs. We aim to determine if the indirect cost impact, added to the traditional healthcare cost analysis, changes the consideration of vaginal approach as the surgical route of choice for benign hysterectomy.…”

Indications and types of hysterectomy in the National Referral Hospital of Bhutan, 2020

“…Total abdominal hysterectomy being the most common type of hysterectomy in our setting is similar to findings reported elsewhere in other studies 3,4,[10][11][12] . However, only 4.4% of the sample had undergone vaginal hysterectomy (VH) despite many studies and other standard guidelines recommending vaginal hysterectomy as the safest route with minimal complications and lowest financial implications including early return to normal life 1,6,9,13,14 . Although VH was performed in older women as compared to TAH, the duration of hospital stay was shortest which is comparable to other studies 1,9,13,14 .…”

“…However, only 4.4% of the sample had undergone vaginal hysterectomy (VH) despite many studies and other standard guidelines recommending vaginal hysterectomy as the safest route with minimal complications and lowest financial implications including early return to normal life 1,6,9,13,14 . Although VH was performed in older women as compared to TAH, the duration of hospital stay was shortest which is comparable to other studies 1,9,13,14 . The shorter hospital stay could be due to lack of abdominal incision scar and surgery being performed under spinal anesthesia, allowing for early ambulation and early return of gastrointestinal function.…”