Resource use for total and supracervical hysterectomies: results of a randomized trial.
OBJECTIVE
Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the "TOSH" trial). We report here an analysis of 24-month resource use by patients in this trial.


METHODS
A randomized controlled trial was performed at 3 clinical centers to compare resources used by 120 patients who received a total or supracervical abdominal hysterectomy. Service use during a 24-month follow-up period was identified from medical and billing records and patient reports. Each service used was assigned a relative value, which was then converted into 2002 U.S. dollars.


RESULTS
Overall resource use was similar in the 2 study groups in the first 12 months after randomization (TAH 5,870 US dollars; SCH 6,018 US dollars; 95% confidence interval for difference -960 US dollars, 1,255 US dollars; P <.79) and for the full 24 months (TAH 6,448 US dollars; SCH 7,479 US dollars; 95% confidence interval for difference -533 US dollars, 2,616 US dollars; P <.20). In exploratory multivariable analyses, resource use was significantly associated with baseline body mass index greater than or equal to 35 kg/m(2) (8,440 US dollars versus 6,398 US dollars, P =.02) and heavy bleeding (7,550 US dollars versus 5,368 US dollars, P =.02).


CONCLUSIONS
We conclude that the use of medical care resources over a 24-month period is comparable for total and supracervical hysterectomy. The association of a woman's weight and bleeding pattern with subsequent resource use requires further investigation.
Showstack
Jonathan
J
Department of Medicine, School of Medicine, University of California, San Francisco, California 94118-1944, USA. jas1@itsa.ucsf.edu
Kuppermann
Miriam
M
Lin
Feng
F
Vittinghoff
Eric
E
Varner
R Edward
RE
Summitt
Robert L
RL
McNeeley
S Gene
SG
Learman
Lee A
LA
Richter
Holly
H
Hulley
Stephen
S
Washington
A Eugene
AE
D000328:Adult; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods*; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000601:surgery*