Laparoscopic supracervical hysterectomy vs. abdominal hysterectomy in a community hospital - A cost comparison

OBJECTIVE: To evaluate the feasibility for an institution to offer laparosc opic supracervical hysterectomy as a cost-effective alternative to total ab dominal hysterectomy (TAH) in a managed care environment. STUDY DESIGN: Retrospective study in which 138 consecutive laparoscopic sup racervical hysterectomies performed between December 1992 and May 1996 were reviewed and compared to 354 consecutive TAHs performed during the same pe riod. Operating time, use of operative room supplies, length of stay and ac tual total,fixed and variable costs of each case were calculated for the en tire hospital stay and for each hospital cost center. Differences between c osts were analyzed by ANCOVA using age, patient weight, specimen weight and number of operative procedures performed at the time of hysterectomy as co variants. RESULTS: The mean operative room time was significantly greater for laparos copic supracervical hysterecto-my than for TAH (167.4 [SD 51.2] vs. 103 min utes [30.3, P < .001]). In contrast, length of stay was significantly short er for laparoscopic supracervical hysterectomy than for TAH (0.8 [SD 1.1] v s. 3.4 days [.9, P < .001]). The adjusted mean costs of both operative room time and supplies were significantly higher for Zaparoscopic supracervical hysterectomy than for TAH (P < .001). In contrast, the mean cost of length of stay for laparoscopic supracervical hysterectomy was significantly lowe r (P < .001). However, the adjusted mean total costs of the entire hospital stay were not significantly different: $2,716 for laparoscopic supracervic al hysterectomy vs. $2,702 for TAH (F = .7, P = .8). The absence of signifi cant differences between procedures resulted from our limited use of dispos able supplies (no automated stapling device) and from shorter lengths of st ay, which compensated well for the higher operative room costs Of time and supplies incurred with laparoscopic suracervical hysterectomy. CONCLUSION: Laparoscopic supracervical hysterectomy is, at least in the sho rt term, a cost-effective alternative to TAH in a managed care environment.