Bauer Hope H, Sahmoud Amine, Rhodes Stephen P, Sheyn David
Division of Urogynecology, Department of Urology, the Department of Obstetrics and Gynecology, and the Department of Urology, University Hospitals, Cleveland, Ohio.
Obstet Gynecol. 2024 Aug 1;144(2):266-274. doi: 10.1097/AOG.0000000000005643. Epub 2024 Jun 13.
To compare inpatient hospital costs and complication rates within the 90-day global billing period among routes of hysterectomy.
The Premier Healthcare Database was used to identify patients who underwent hysterectomy between 2000 and 2020. Current Procedural Terminology codes were used to group patients based on route of hysterectomy. Comorbidities and complications were identified using International Classification of Diseases codes. Fixed, variable, and total costs for inpatient care were compared. Fixed costs consist of costs that are set for the case, such as operating room time or surgeon costs. Variable costs include disposable and reusable items that are billed additionally. Total costs equal fixed and variable costs combined. Data were analyzed using analysis of variance, t test, and χ 2 test, as appropriate. Factors independently associated with increased total costs were assessed using linear mixed effects models. Multivariate logistic regression was performed to evaluate associations between the route of surgery and complication rates.
A cohort of 400,977 patients were identified and grouped by route of hysterectomy. Vaginal hysterectomy demonstrated the lowest inpatient total cost ($6,524.00 [interquartile range $4,831.60, $8,785.70]), and robotic-assisted laparoscopic hysterectomy had the highest total cost ($9,386.80 [interquartile range $6,912.40, $12,506.90]). These differences persisted with fixed and variable costs. High-volume laparoscopic and robotic surgeons (more than 50 cases per year) had a decrease in the cost difference when compared with costs of vaginal hysterectomy. Abdominal hysterectomy had a higher rate of complications relative to vaginal hysterectomy (adjusted odds ratio [aOR] 1.52, 95% CI, 1.39-1.67), whereas laparoscopic (aOR 0.85, 95% CI, 0.80-0.89) and robotic-assisted (aOR 0.92, 95% CI, 0.84-1.00) hysterectomy had lower rates of complications compared with vaginal hysterectomy.
Robotic-assisted hysterectomy is associated with higher surgical costs compared with other approaches, even when accounting for surgeon volume. Complication rates are low for minimally invasive surgery, and it is unlikely that the robotic-assisted approach provides an appreciable improvement in perioperative outcomes.
比较子宫切除术中不同术式在90天全球计费周期内的住院费用和并发症发生率。
利用Premier医疗数据库识别2000年至2020年间接受子宫切除术的患者。使用当前手术操作术语编码根据子宫切除的术式对患者进行分组。使用国际疾病分类编码识别合并症和并发症。比较住院护理的固定成本、可变成本和总成本。固定成本包括针对该病例设定的成本，如手术室时间或外科医生费用。可变成本包括额外计费的一次性和可重复使用物品。总成本等于固定成本和可变成本之和。根据情况，使用方差分析、t检验和χ²检验对数据进行分析。使用线性混合效应模型评估与总成本增加独立相关的因素。进行多变量逻辑回归以评估手术方式与并发症发生率之间的关联。
共识别出400977例患者，并根据子宫切除的术式进行分组。经阴道子宫切除术的住院总成本最低（6524.00美元[四分位间距4831.60美元，8785.70美元]），机器人辅助腹腔镜子宫切除术的总成本最高（9386.80美元[四分位间距6912.40美元，12506.90美元]）。固定成本和可变成本方面这些差异依然存在。与经阴道子宫切除术的成本相比，高手术量的腹腔镜和机器人手术外科医生（每年超过50例手术）的成本差异有所减小。与经阴道子宫切除术相比，经腹子宫切除术的并发症发生率更高（校正比值比[aOR]1.52，95%置信区间[CI]，1.39 - 1.67），而腹腔镜（aOR 0.85，95% CI，0.80 - 0.89）和机器人辅助（aOR 0.92，95% CI，0.84 - 1.00）子宫切除术与经阴道子宫切除术相比并发症发生率更低。
与其他手术方式相比，即使考虑外科医生手术量，机器人辅助子宫切除术的手术成本更高。微创手术的并发症发生率较低，机器人辅助手术方式不太可能在围手术期结局方面带来显著改善。
