title: Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.
abstract: OBJECTIVE
  To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy.
  
  
  METHODS
  A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost.
  
  
  RESULTS
  Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost.
  
  
  CONCLUSIONS
  Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs.
authors: The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors: Yoon J J
authors: YJ
authors: Rhou
authors: The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors: Selvan
authors: S
authors: Pather
authors: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors: John A
authors: JA
authors: Loadsman
authors: Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors: Neil
authors: N
authors: Campbell
authors: The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|Sydney School of Nursing University of Sydney, Sydney, New South Wales, Australia.
authors: Shannon
authors: S
authors: Philp
authors: The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.|Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors: Jonathan
authors: J
authors: Carter
mesh_terms: D016022:Case-Control Studies; D003953:Diagnosis-Related Groups / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D004434:Early Ambulation; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D007432:Intraoperative Period; D010535:Laparoscopy / Q000191:economics* / Q000295:instrumentation; D059032:Learning Curve; D011184:Postoperative Period; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics
keywords: fast-track; laparoscopic hysterectomy; open hysterectomy