OPERATIVE MANAGEMENT OF ECTOPIC PREGNANCY - A COST-ANALYSIS

OBJECTIVES: The purpose of this study was to analyze the cost for hosp ital-based services related to the operative management of ectopic pre gnancies and determine the most cost-conscious approach by distinguish ing the constituent components. STUDY DESIGN: This is a retrospective comparative review of every ectopic pregnancy that was surgically mana ged at the Memorial Medical Center of Long Beach. Unit cost estimates that are based on a cost accounting system were derived and compared b etween different procedures according to resources used among separate services. RESULTS: Hemodynamic instability significantly increases th e cost of management by increasing the length of stay and laboratory c osts. Among stable patients laparoscopic excision of ectopic pregnanci es saves nearly 25% per case (p < 0.001) compared with laparotomy. How ever, when we compared all intended laparoscopic excisions (i.e., incl uding the 21% of cases in which laparotomy was eventually done), the s avings were markedly reduced. In addition, the cost savings was lost i f patients undergoing laparotomy were discharged on or before postoper ative day 2. Discharging patients after laparotomy on postoperative da y 1 is the least costly management for operative treatment of ectopic pregnancy. CONCLUSIONS: Whereas laparoscopy may decrease recuperation time and incisional scarring, operative cost is not a significant reas on to choose laparoscopy over laparotomy in a hemodynamically stable p atient, especially as postoperative stays decrease.