title: Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies.
abstract: OBJECTIVE
  To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal, vaginal, laparoscopic, and robotic techniques.
  
  
  METHODS
  We performed a retrospective cohort analysis (Canadian Task Force classification II-2) of all patients who underwent a hysterectomy for benign reasons in 2009 at a single urban academic tertiary care center using the χ(2) test and Student t test. A multivariate regression analysis was also performed for predictors of costs. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patient's medical records.
  
  
  RESULTS
  In 2009, 688 patients underwent a benign hysterectomy; 185 (26.9%) hysterectomies were abdominal, 135 (19.6%) vaginal, 352 (51.5%) laparoscopic, and 14 (2.0%) robotic. The rate of intraoperative complication was 1.7% for abdominal, 0.8% for vaginal, 0.3% for laparoscopic, and 0 for robotic. Mean total patient costs were $43,622 for abdominal, $31,934 for vaginal, $38,312 for laparoscopic, and $49,526 for robotic hysterectomies. Costs were significantly influenced by method of hysterectomy, operative time, and length of stay.
  
  
  CONCLUSIONS
  Though complication rates did not vary significantly among minimally invasive methods of hysterectomy, patient costs were significantly influenced by the method of hysterectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA. knwright@partners.org
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Wright
authors.forename: Gudrun M
authors.initials: GM
authors.lastname: Jonsdottir
authors.forename: Selena
authors.initials: S
authors.lastname: Jorgensen
authors.forename: Neel
authors.initials: N
authors.lastname: Shah
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D005831:Genital Diseases, Female / Q000191:economics* / Q000601:surgery; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics* / Q000379:methods; D014481:United States