Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy.
OBJECTIVE
The objective of the study was to determine total hospital costs and net hospital income for different types of minimally invasive hysterectomy and financial impact if a subset of patients underwent total vaginal hysterectomy (TVH) instead of their selected procedure.


METHODS
A retrospective chart review was performed of patients who underwent hysterectomy for benign disease by TVH, laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), and robotic hysterectomy (RH) between Jan. 1, 2007, and April 30, 2010, at Thomas Jefferson University Hospital. The hospital decision support database was used to calculate net hospital income. A subset of patients with at least 1 prior vaginal delivery, no more than 1 laparotomy, and a uterine size less than 14 weeks who had undergone RH, TLH, or LAVH was identified as potential TVH candidates. The financial impact of performing TVH over the selected hysterectomy was calculated.


RESULTS
Three hundred thirty-four cases of minimally invasive hysterectomy were identified. Fifty-five percent were TVH, 33% LAVH, 3% TLH, and 9% RH. Mean total hospital costs for TVH were $7903, $10,069 for LAVH, $11,558 for TLH, and $13,429 for RH (P < .0001). Net hospital income was $1260 for TVH. The hospital incurred losses of $-1306 for LAVH, $-4049 for TLH, and $-4564 for RH (P = .03). Our criteria to determine the mode of hysterectomy increased TVH from 57% to 76% of all minimally invasive hysterectomy.


CONCLUSIONS
Hospital costs were greater with LAVH, TLH, and RH than for TVH. The hospital incurred financial losses with LAVH, TLH, and RH. TVH was the only minimally invasive modality of hysterectomy that generated net hospital income. Our conservative criteria to determine the route of hysterectomy would increase the number of TVHs by more than 30%.
Department of Obstetrics and Gynecology, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, WV. Electronic address: sdayarat@gmail.com.
Sandra
S
Dayaratna
Department of Obstetrics and Gynecology, Einstein Medical Center, Philadelphia, PA.
Jay
J
Goldberg
Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
Christine
C
Harrington
Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, Philadelphia, PA.
Benjamin E
BE
Leiby
Department of Financial Administration, Thomas Jefferson University Hospital, Philadelphia, PA.
Jean M
JM
McNeil
D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D007045:Hysterectomy, Vaginal / Q000191:economics*; D007182:Income; D010535:Laparoscopy / Q000191:economics; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics
cost; robotic hysterectomy; vaginal hysterectomy