Departments of Urology and Obstetrics and Gynecology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA.
Int Urogynecol J. 2023 May;34(5):1121-1126. doi: 10.1007/s00192-022-05445-6. Epub 2023 Feb 2.
Minimally invasive sacrocolpopexy (MISCP) is increasingly used for uterovaginal prolapse, but comparative cost data of MISCP versus native tissue vaginal repair (NTR) are lacking. The objective was to determine the cost difference, from a hospital perspective, between MISCP and NTR performed with hysterectomy for uterovaginal prolapse.
This was a retrospective cohort study at a tertiary care center of women who underwent NTR or MISCP with concomitant hysterectomy in 2021. Hospital charges, direct and indirect costs, and operating margin (revenue minus costs) were obtained from Strata Jazz and compared using SPSS.
A total of 82 women were included, 33 MISCP (25 robotic, 8 laparoscopic) versus 49 NTR. Demographic and surgical data were similar, except that MISCP had younger age (50.5 vs 61.1 years, p<0.01). Same-day discharge and estimated blood loss were similar, but operative time was longer for MISCP (204 vs 161 min, p<0.01). MISCP total costs were higher (US$17,422 vs US$13,001, p<0.01). MISCP had higher direct costs (US$12,354 vs US$9,305, p<0.01) and indirect costs (US$5,068 vs US$3,696, p<0.01). Consumable supply costs were higher with MISCP (US$4,429 vs US$2,089, p<0.01), but the cost of operating room time and staff was similar (US$7,926 vs US$7,216, p=0.07). Controlling for same-day discharge, anti-incontinence procedures and smoking, total costs were higher for MISCP (adjusted beta = US$4,262, p<0.01). Mean charges (US$102,060 vs US$97,185, p=0.379), revenue (US$22,214 vs US$22,491, p=0.929), and operating margin (US$8,719 vs US$3,966, p=0.134) were not statistically different.
Minimally invasive sacrocolpopexy had higher costs than NTR; however, charges, reimbursement, and operating margins were not statistically significantly different between the groups.
经阴道微创骶骨阴道固定术（MISCP）越来越多地用于治疗子宫阴道脱垂，但缺乏 MISCP 与阴道固有组织修复术（NTR）的成本比较数据。本研究旨在从医院角度确定在治疗子宫阴道脱垂时，MISCP 与 NTR 联合子宫切除术的成本差异。
这是一项在一家三级护理中心进行的回顾性队列研究，纳入了 2021 年接受 NTR 或 MISCP 联合子宫切除术的女性。从 Strata Jazz 中获得医院收费、直接和间接成本以及运营利润（收入减去成本），并使用 SPSS 进行比较。
共纳入 82 名女性，33 例行 MISCP（25 例行机器人手术，8 例行腹腔镜手术），49 例行 NTR。人口统计学和手术数据相似，但 MISCP 组年龄更轻（50.5 岁 vs 61.1 岁，p<0.01）。两组患者的日间出院率和估计失血量相似，但 MISCP 的手术时间更长（204 分钟 vs 161 分钟，p<0.01）。MISCP 的总费用更高（17422 美元 vs 13001 美元，p<0.01）。MISCP 的直接成本更高（12354 美元 vs 9305 美元，p<0.01），间接成本也更高（5068 美元 vs 3696 美元，p<0.01）。MISCP 的耗材供应成本更高（4429 美元 vs 2089 美元，p<0.01），但手术室时间和人员的成本相似（7926 美元 vs 7216 美元，p=0.07）。在控制日间出院、抗失禁手术和吸烟因素后，MISCP 的总费用更高（调整后β=4262 美元，p<0.01）。MISCP 的平均收费（102060 美元 vs 97185 美元，p=0.379）、收入（22214 美元 vs 22491 美元，p=0.929）和运营利润（8719 美元 vs 3966 美元，p=0.134）无统计学差异。
与 NTR 相比，经阴道微创骶骨阴道固定术的成本更高；但两组间的收费、报销和运营利润无统计学差异。
