COMPARATIVE MORBIDITY AND CHARGES ASSOCIATED WITH ROUTE OF HYSTERECTOMY AND CONCOMITANT BURCH COLPOSUSPENSION

Objective: To compare the surgical morbidity, postoperative course, an d hospital charges of Burch colposuspension performed in conjunction w ith abdominal versus vaginal hysterectomy. Methods: Power analysis ind icated that 35 women would be needed in each group to detect a 20% dif ference in hospital charges between groups with a beta error of 20% an d an alpha error of 5%. A computerized records search identified 80 wo men who underwent Burch colposuspension, 40 of whom underwent concomit ant vaginal hysterectomy (vaginal group) and 40 of whom underwent conc omitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cin cinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgi a, between 1992 and 1996. Data on demographics, perioperative course, uterine weight, and operative and total hospital charges were obtained for each group. Results: There was no statistically significant diffe rence in demographics, surgical history, postoperative hemoglobin and hematocrit decrease, postoperative complications (10 versus 23%), oper ative charges ($4417 +/- 1200 versus $4731 +/- 1453), mean uterine wei ght (113.5 +/- 45 versus 125.8 +/- 45 g), and operative times (3.0 +/- 0.8 versus 2.9 +/- 0.7 hours) between the vaginal and abdominal group s, respectively. A post hoc power analysis indicated that each group w ould require 142 patients to achieve statistical significance for post operative complication rates. The abdominal group had significantly lo nger hospital stays (3.1 +/- 1.0 versus 2.6 +/- 0.7 days) and higher h ospital charges ($7337 +/- 1828 versus $6342 +/- 1123) than the vagina l group. Conclusion: When hysterectomy is performed at the time of col posuspension, the vaginal route should be considered seriously when ei ther surgical approach is clinically appropriate. (C) 1997 by The Amer ican College of Obstetricians and Gynecologists.