Predictors of the cost of hysterectomy for benign indications

被引:11
作者
AlAshqar, Abdelrahman [1 ,2 ]
Goktepe, Metin E. [3 ]
Kilic, Gokhan S. [4 ]
Borahay, Mostafa A. [1 ]
机构
[1] Johns Hopkins Univ, Dept Gynecol & Obstet, 4940 Eastern Ave, Baltimore, MD 21224 USA
[2] Kuwait Univ, Dept Obstet & Gynecol, Kuwait, Kuwait
[3] Univ Texas Med Branch, Galveston, TX 77555 USA
[4] Univ Texas Med Branch, Dept Obstet & Gynecol, Galveston, TX 77555 USA
关键词
Hysterectomy; Laparoscopy; Length of stay; Minimally invasive surgery; Robotic-assisted surgery; LAPAROSCOPIC HYSTERECTOMY; FINANCIAL ANALYSIS; OPERATING-ROOM; OUTCOMES; SURGERY; TRENDS;
D O I
10.1016/j.jogoh.2020.101936
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Introduction: Hysterectomy is a commonly performed procedure with widely variable costs. As gynecologists divert from invasive to minimally invasive approaches, many factors come into play in determining hysterectomy cost and efforts should be sought to minimize it. Our objective was to identify the predictors of hysterectomy cost. Materials and Methods: This was a retrospective cohort study where women who underwent hysterectomy for benign conditions at the University of Texas Medical Branch from 2009 to 2016 were identified. We obtained and analyzed demographic, operative, and financial data from electronic medical records and the hospital finance department. Results: We identified 1,847 women. Open hysterectomy was the most frequently practiced (35.8 %), followed by vaginal (23.7 %), laparoscopic (23.6 %), and robotic (16.9 %) approaches. Multivariate regression demonstrated that hysterectomy charges can be significantly predicted from surgical approach, patient's age, operating room (OR) time, length of stay (LOS), estimated blood loss, insurance type, fiscal year, and concomitant procedures. Charges increased by $3,723.57 for each day increase in LOS (P <0.001), by $76.02 for each minute increase in OR time (P <0.001), and by $48.21 for each one-year increase in age (P 0.037). Adjusting for LOS and OR time remarkably decreased the cost of open and robotic hysterectomy, respectively when compared with the vaginal approach. Conclusion: Multiple demographic and operative factors can predict the cost of hysterectomy. Healthcare providers, including gynecologists, are required to pursue additional roles in proper resource management and be acquainted with the cost drivers of therapeutic interventions. Future efforts and policies should target modifiable factors to minimize cost and promote value-based practices. (C) 2020 Elsevier Masson SAS. All rights reserved.
引用
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页数:7
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