Dorsey J H, Holtz P M, Griffiths R I, McGrath M M, Steinberg E P
Department of Gynecology, Greater Baltimore Medical Center, MD 21204, USA.
N Engl J Med. 1996 Aug 15;335(7):476-82. doi: 10.1056/NEJM199608153350705.
Many hysterectomies are now performed by a laparoscopically assisted vaginal technique. This procedure is controversial, partly because of concern about cost. We studied hospital charges and costs for the procedure as compared with those for total abdominal hysterectomy and total vaginal hysterectomy in clinically similar groups of patients.
From hospital-discharge data and patients' charts, we identified hysterectomies performed in 1993 and 1994 by 96 surgeons at a community teaching hospital to treat benign conditions. The patients were grouped according to the surgical procedures performed in conjunction with the hysterectomy. Data on hospital charges and cost-to-charge ratios for 64 hospital cost centers were used to assess charges and costs for specific resources, as well as for the hospitalization overall.
Of 1049 patients studied, 26 percent underwent laparoscopically assisted vaginal hysterectomy, 54 percent underwent abdominal hysterectomy, and 20 percent underwent vaginal hysterectomy. The average hospital stays were 2.6, 3.9, and 2.9 days, respectively, and the mean total charges (facility charges plus professional fees) for the hospitalizations were $6,116, $5,084, and $4,221 (P<0.001 for the comparison of the laparoscopic technique with both other techniques). The mean facility costs were $4,914, $3,954, and $3,116, respectively (P<0.001 for the same comparison), with similar findings in all subgroups. The higher charges and costs for laparoscopically assisted vaginal hysterectomy were due to higher supply costs, particularly when disposable supplies were used, and to longer operating-room time.
Despite shorter hospital stays, in-hospital charges and costs for laparoscopically assisted vaginal hysterectomy are higher than for either alternative procedure, because of the disposable supplies that are typically used and the longer operating-room time.
目前许多子宫切除术是通过腹腔镜辅助阴道技术进行的。该手术存在争议，部分原因是对成本的担忧。我们研究了该手术与全腹式子宫切除术和全阴道式子宫切除术相比在临床相似患者组中的住院费用和成本。
从医院出院数据和患者病历中，我们确定了1993年和1994年在一家社区教学医院由96位外科医生进行的用于治疗良性疾病的子宫切除术。患者根据与子宫切除术同时进行的手术程序进行分组。使用64个医院成本中心的住院费用和成本收费比率数据来评估特定资源以及总体住院的费用和成本。
在研究的1049例患者中，26%接受了腹腔镜辅助阴道子宫切除术，54%接受了腹式子宫切除术，20%接受了阴道子宫切除术。平均住院天数分别为2.6天、3.9天和2.9天，住院的平均总费用（设施费用加专业费用）分别为6116美元、5084美元和4221美元（腹腔镜技术与其他两种技术相比，P<0.001）。平均设施成本分别为4914美元、3954美元和3116美元（相同比较，P<0.001），所有亚组均有类似发现。腹腔镜辅助阴道子宫切除术较高的费用和成本是由于供应成本较高，特别是使用一次性用品时，以及手术时间较长。
尽管住院时间较短，但由于通常使用一次性用品和手术时间较长，腹腔镜辅助阴道子宫切除术的住院费用和成本高于其他任何一种替代手术。
