title: Geographic Variance of Cost Associated With Hysterectomy.
abstract: To estimate whether the cost of hysterectomy varies by geographic region.
  
  
  
  This was a cross-sectional, population-based study using the 2013 Healthcare Cost and Utilization Project National Inpatient Sample of women older than 18 years undergoing inpatient hysterectomy for benign conditions. Hospital charges obtained from the National Inpatient Sample database were converted to actual costs using cost-to-charge ratios provided by the Healthcare Cost and Utilization Project. Multivariate regression was used to assess the effects that demographic factors, concomitant procedures, diagnoses, and geographic region have on hysterectomy cost above the median.
  
  
  
  Women who underwent hysterectomy for benign conditions were identified (N=38,414). The median cost of hysterectomy was $13,981 (interquartile range $9,075-29,770). The mid-Atlantic region had the lowest median cost of $9,661 (interquartile range $6,243-15,335) and the Pacific region had the highest median cost, $22,534 (interquartile range $15,380-33,797). Compared with the mid-Atlantic region, the Pacific (adjusted odds ratio [OR] 10.43, 95% confidence interval [CI] 9.44-11.45), South Atlantic (adjusted OR 5.39, 95% CI 4.95-5.86), and South Central (adjusted OR 2.40, 95% CI 2.21-2.62) regions were associated with the highest probability of costs above the median. All concomitant procedures were associated with an increased cost with the exception of bilateral salpingectomy (adjusted OR 1.03, 95% CI 0.95-1.12). Compared with vaginal hysterectomy, laparoscopic and robotic modes of hysterectomy were associated with higher probabilities of increased costs (adjusted OR 2.86, 95% CI 2.61-3.15 and adjusted OR 5.66, 95% CI 5.11-6.26, respectively). Abdominal hysterectomy was not associated with a statistically significant increase in cost compared with vaginal hysterectomy (adjusted OR 1.01, 95% CI 0.91-1.09).
  
  
  
  The cost of hysterectomy varies significantly with geographic region after adjusting for confounders.
authors.affiliation: Department of Obstetrics and Gynecology and Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Sheyn
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mahajan
authors.forename: Megan
authors.initials: M
authors.lastname: Billow
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fleary
authors.forename: Emi
authors.initials: E
authors.lastname: Hayashi
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D014481:United States; D014591:Uterine Diseases / Q000601:surgery*; D014932:Women's Health Services / Q000191:economics / Q000706:statistics & numerical data