Types of hysterectomy. Comparison of characteristics, hospital costs, utilization and outcomes

To compare hospital costs, patient characteristics and outcomes of 3 hysterectomy techniques--abdominal, vaginal and laparoscopically assisted vaginal (LAVH).

A cross-sectional analysis was performed using patients discharged from Florida hospitals in 2000 with hysterectomy as the primary procedure. To avoid differences due to unrelated complications, records indicating cancer or other major non-hysterectomy-related procedure were excluded from the analysis. A total of 23,191 records were used to compare the 3 techniques on hospital costs and length of stay, controlling for patient differences in complicating diagnoses and related procedures.

Consistent with previous studies, patients undergoing LAVH had higher hospital costs, shorter lengths of stay and no difference in surgical complications from either vaginal or total abdominal hysterectomy, even after controlling for patient comorbidities. Other factors affecting hospital costs and length of stay were patient race, type of insurance, hospital ownership and location.

LAVH is still more expensive than vaginal and total abdominal hysterectomy but offers a speedier recovery, with no measurable difference in the rate of complications. Further research is warranted to ascertain differences in readmission rates across the techniques and to investigate the process used to select which hysterectomy technique is used for a given patient.