Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies

To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler.

Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated. Operating room, postoperative hospitalization, and pharmacy costs were compared. Independent, two-tailed Student t test analysis was performed.

The mean cost of performing laparoscopy-assisted vaginal hysterectomy with the linear stapler ($7161.66) was significantly higher (P < .05) than that of both vaginal hysterectomy ($4868.06) and TAH ($4926.80). The cost of vaginal hysterectomy was nonsignificantly lower (P > .05) than that of TAH. The mean operating room supplies and equipment charge for laparoscopy-assisted vaginal hysterectomy with the linear stapler ($2468.43) was, as expected, significantly higher (P < .05) than those for both abdominal ($716.65) and vaginal ($676.16) procedures. The average operating room time charge for laparoscopy-assisted vaginal hysterectomy ($1264.56) was also significantly higher (P < .05) than for the other two procedures (TAH $642.76, vaginal hysterectomy $955.66). The mean total pharmacy charges were similar for all groups ($1114.27 for laparoscopy-assisted vaginal hysterectomy, $1163.16 for vaginal hysterectomy, and $1098.71 for TAH). Reflecting the longer operating time for laparoscopy-assisted vaginal hysterectomy, the intraoperative pharmacy costs were significantly higher for this type ($417.00) than for the TAH patients ($290.62). The difference, however, was almost erased when postoperative pharmacy charges were included, reflecting the lower cost of a shorter hospital stay in the laparoscopy-assisted vaginal hysterectomy group. Some savings were realized by laparoscopy-assisted vaginal hysterectomy when postoperative hospitalization charges were considered. The average hospitalization time was 2.3 days for laparoscopy-assisted vaginal hysterectomy, 3.0 days for vaginal hysterectomy, and 3.3 for TAH.

The cost savings expected with the advent of laparoscopy-assisted vaginal hysterectomy when performed with the linear stapler have not been realized at present. In most cost categories studied, the use of laparoscopy to perform a hysterectomy was associated with much higher costs. The predicted savings associated with the shorter hospital stay in these patients failed to offset the exorbitant intraoperative costs. However, when bipolar electrocoagulation with the CO2 laser and reusable instruments replace staplers and disposables, respectively, the projected savings are appreciated.