Value‐based assessment of hysterectomy approaches

Abstract

Aim By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. Methods Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. Results Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. Conclusion Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value.

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

“…In an effort to push the healthcare system in the direction of greater sustainability, comparisons of surgical settings should also be framed in the context of value, examining the costs relative to outcomes and patient satisfaction, rather than analyzing individual metrics alone. 26 The patient characteristics and surgical outcomes were comparable between the ASC and hospital study groups, supporting the idea that LAM can be safely performed by skilled surgeons in a freestanding ambulatory setting, without limitations in patient complexity. With the stated advantages of the ASC setting, this study contributes to the growing body of evidence that ASCs are both a viable and safe setting for advanced gynecologic procedures, and are key to meeting the growing demand for outpatient surgery.…”

“…While the focus of our study was on the safety and feasibility of performing LAM at a freestanding ASC, future studies should include direct cost comparisons between settings. In an effort to push the healthcare system in the direction of greater sustainability, comparisons of surgical settings should also be framed in the context of value, examining the costs relative to outcomes and patient satisfaction, rather than analyzing individual metrics alone …”

Cost measurement in value-based healthcare: a systematic review

“…Some studies omitted certain cost categories such as equipment. 57 Direct costing enabled cost drivers to be identified, [60][61][62] and in some cases granular cost measurement.…”

Complicaciones intra y post operatorias de las histerectomías: laparoscópica, abdominal y vaginal en mujeres adultas.

“…Liang et al,(29) hacen una comparación directa entre la histerectomía radical laparoscópica y la abdominal, encontrando que la técnica laparoscópica tiene un mayor riesgo de complicaciones quirúrgicas mayores.La histerectomía radical, ya sea con linfadenectomía pélvica o asistida por robot, también presenta desafíos. Wenzel et al,(40) señalan que el 35% de los pacientes desarrollaron complicaciones quirúrgicas dentro de los 30 días posteriores a la intervención.Jin et al,(30), por su parte, reportan que la histerectomía radical robótica tiene bajos índices de complicaciones, lo que sugiere que la asistencia robótica puede ofrecer ventajas en términos de precisión y reducción de complicaciones.Uppal et al,(41) destacan que la histerectomía convertida se asocia con una mayor probabilidad de complicaciones, mientras que Danilyants et al,(42) comparan múltiples técnicas, encontrando que la histerectomía vaginal total tiene las tasas más altas de complicaciones intraoperatorias y que la técnica robótica presenta la tasa más alta de complicaciones postoperatorias.En el análisis de las complicaciones intraoperatorias y postoperatorias de las histerectomías, se observan patrones y semejanzas en función de la técnica empleada. Las histerectomías abdominales, como las descritas por Sentilhes et al,(27) destacan la pérdida de sangre total estimada superior a 3000 ml y lesiones a órganos adyacentes.…”