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Changing hysterectomy patterns after introduction of laparoscopically assisted vaginal hysterectomy.

Abstract：

OBJECTIVE:The objective of this study was to determine whether introduction of laparoscopically assisted vaginal hysterectomy decreases the percentage of women requiring laparotomy for hysterectomy. STUDY DESIGN:A retrospective review of women undergoing hysterectomies from 1990 through 1992 was performed. Type of hysterectomy and total hospital charges were determined. Indication for surgery and complications in the laparoscopically assisted vaginal hysterectomy group were also examined. RESULTS:During the study interval 670 hysterectomies were performed. In 1990 and 1991 abdominal hysterectomies comprised 51.5% and 45.5% of all hysterectomies, respectively. After introduction of laparoscopically assisted vaginal hysterectomy in 1992 the percentage of abdominal hysterectomies declined to 35.6%, whereas the percentage of unassisted vaginal hysterectomies remained stable. The complication rate for patients with laparoscopically assisted vaginal hysterectomy was 16%. Average cost was $11,931 compared with $7031 for abdominal hysterectomy and $5343 for vaginal hysterectomy. CONCLUSION:Laparoscopically assisted vaginal hysterectomy can decrease the number of patients requiring a laparotomy for hysterectomy but at a much greater cost. :Physicians reviewed the records of all 670 patients at Southeastern Regional Medical Center in Lumberton, North Carolina, who underwent hysterectomy during 1990-1992 to compare the differences between abdominal hysterectomies and laparoscopically assisted vaginal hysterectomy. The proportion of abdominal hysterectomies at the center fell considerably after introduction of laparoscopically assisted vaginal hysterectomy in 1992 (51.5% in 1990, 45.5% in 1991, and 35.6% in 1992; p = .0012). The proportion of unassisted vaginal hysterectomies did not change, however (e.g., 54.5% in 1991 and 54.3% in 1992). The mean length of stay was longer for abdominal hysterectomy patients than for unassisted and laparoscopically assisted vaginal hysterectomy patients (4.03 vs. 2.65 and 2.32 days, respectively; p = .0001). Hospital costs were significantly greater for laparoscopically assisted vaginal hysterectomy than for the other 2 hysterectomy methods ($11,931 vs. $7,031 for abdominal and $5343 unassisted vaginal; p = .0001). Increased operating time and charges for disposable staples and other instruments accounted for the increased costs. Laparoscopically assisted vaginal hysterectomy patients suffered complications at basically the same rate as the abdominal and unassisted vaginal hysterectomy groups (16% vs. 20% and 12%, respectively). These results suggest that even though laparoscopically assisted vaginal hysterectomy can reduce the number of patients who need to undergo laparotomy for a hysterectomy, the hospital costs are much greater for than the conventional method.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Harris MB,Olive DL

doi

10.1016/s0002-9378(94)70032-x

subject

Has Abstract

pub_date

1994-08-01 00:00:00

pages

340-3; discussion 343-4

issue

eissn

0002-9378

issn

1097-6868

pii

S000293789400236X

journal_volume

171

pub_type

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Changing hysterectomy patterns after introduction of laparoscopically assisted vaginal hysterectomy.