Cost Drivers for Benign Hysterectomy in a Healthcare System, 2013-2019

Abstract

Study Objective To analyze the association of patient factors and surgical indications with hospital charges between hysterectomy approaches (laparoscopic, robotic-assisted, abdominal, and vaginal). Design Retrospective study from 7/2013–2/2019 using the Premier Healthcare Database (clinical and financial data from hospital-based outpatient and inpatient encounters). Comorbidities were assessed using the Elixhauser Index. Total charges adjusted for inflation using Consumer Price Index. Multivariate linear regression performed to identify factors affecting total charges. Setting Integrated healthcare system including five academic and community hospitals in one region. Patients or Participants 4,523 women age 18–88 years underwent hysterectomy for benign indications (fibroids, abnormal uterine bleeding [AUB], endometriosis, pelvic organ prolapse [POP], and other indications). Interventions N/A Measurements and Main Results Most common indication across all approaches was fibroids (50%), then AUB (17%), endometriosis (9%), POP (9%) and other diagnoses (15%). Median age was 47 years (IQR 42-52 years). The sample was 53% White, 35% Black, and 12% other races; 7% were Hispanic. 51% had no comorbidities, 25% had one comorbidity, and 24% had two or more. 28% were discharged on POD#0, 47% on POD#1, 14% on POD#2, and 11%% on POD#3 or later. Median charges were $11,908 for laparoscopic, $14,574 for robotic-assisted, $17,162 for abdominal, and $11,954 for vaginal. In regression, charges for hysterectomy were affected significantly by surgical approach, indication, year, age, race/ethnicity, comorbidities, length of stay, and hospital site (p Additional charges for robotic-assisted hysterectomy compared to laparoscopic were smallest for fibroids and greatest for POP. Laparoscopic hysterectomy was less expensive than abdominal only for endometriosis. Conclusion The added charges for a robotic-assisted laparoscopic approach can be minimized if employed for appropriate benign surgical indications, particularly fibroid uteri.