[Operative approaches, indications, and medical economics evaluation of 4180 cases of hysterectomy].
OBJECTIVE
To examine the operative approaches, major indications, and medical economic parameters of the hysterectomy.


METHODS
Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed.


RESULTS
Records of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH.


CONCLUSIONS
The use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.
Tan
Xian-jie
XJ
Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China. tanxj@csc.pumch.ac.cn
Lang
Jing-he
JH
Shen
Keng
K
Liu
Zhu-feng
ZF
Sun
Da-wei
DW
Leng
Jin-hua
JH
Zhu
Lan
L
D003365:Costs and Cost Analysis; D005069:Evaluation Studies as Topic; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics*; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*