Cost Analysis of Laparoscopic Hysterectomy, Abdominal Hysterectomy, and Vaginal Hysterectomy in a Canadian Teaching Hospital

Abstract

Objectives: To compare in-hospital costs of total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH) in a Canadian teaching hospital.Study Design: A retrospective cost analysis using the hospital administrative database at the Royal Victoria Hospital, Montreal, Quebec, Canada.Results: The subjects consisted of women having hysterectomies for benign pathology between April 1, 1996 and November 6, 1999. These included 610 women having TAHs, 297 women having VHs, and 21 women having LHs. The subjects who underwent a VH were significantly older than the subjects who underwent a TAH and LH (53.1, 46.4, and 42.2 years respectively; p < 0.0001). The average length of hospital stay was shorter for women having LHs (2.2 ± 0.2 days) compared to women having TAHs (4.9 ± 0.1 days) and women having VHs (4.2 ± 0.1 days); p < 0.0001. The major admitting diagnosis for TAH was uterine leiomyoma (64.6%); for VH, uterovaginal prolapse (46.5%); and for LH, uterine leiomyoma (66.7%). The operating room cost per patient CAD for LH ($722.97) was significantly higher than in TAH ($662.15) and VH ($691.21, p < 0.001). The nursing cost per patient, however, was lower in LH ($555.01) than in TAH ($1254.79) and in VH ($1058.14, p < 0.0001. The overall cost per patient was lower in LH ($1316.92) than in TAH ($1993.32) and VH ($1814.73), p < 0.0001).Conclusion: Compared to abdominal and vaginal hysterectomies, laparoscopic hysterectomy is associated with a higher operating room cost but the hospital stay is shorter and the nursing costs are lower. This results in lower total in-hospital costs.