Effect of Route of Hysterectomy on Cost in a National Sample

Thursday, October 5, 2023

12:14 PM – 12:18 PM US PST

Location: Oregon Ballroom

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Image Label: Figure 1. Patient selection

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Image Label: Figure 2. Minimally Invasive Hysterectomy Utilization by Geographical Region in the US (National Inpatient Sample 2010-2015)

Presenting Author(s)

Keziah M. Daniels (she/her/hers)

Medical Student
Emory University School of Medicine
Tucker, Georgia, United States

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Co-Author(s)

Sherif El-Nashar, MD

Urogynecologist and Associate Professor of Obstetrics and Gynecology
Mayo Clinic
Jacksonville, Florida, United States
AM

April M. Miller, MD (she/her/hers)

Resident Physician
Cleveland Clinic
Cleveland, Ohio, United States
AM

Amr Mahran, MD

Associate Professor
Assiut University
Assiut, Asyut, Egypt
MI

Mostafa Ibrahim, MD

Associate Professor
Assiut University
Assiut, Asyut, Egypt
JN

John Nakayama, MD

Physician
Allegheny Health Network
Pittsburgh, Pennsylvania, United States
AC

Anita Chen, MD

Assistant Professor
Mayo Clinic
Jacksonville, Florida, United States
Anne G. Sammarco, MD, MPH (she/her/hers)

Assistant Professor
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States
David Sheyn, MD (he/him/his)

Associate Professor of Urology and Reproductive Biology Division Director, Female Pelvic Medicine and Reconstructive Surgery
University Hospitals System Urology Institute
Pepper pike, Ohio, United States

Disclosure(s):

Keziah M. Daniels: No financial relationships to disclose

Sherif El-Nashar, MD: No financial relationships to disclose

April M. Miller, MD: No financial relationships to disclose

Amr Mahran, MD: No financial relationships to disclose

Mostafa Ibrahim, MD: No financial relationships to disclose

John Nakayama, MD: AstraZeneca: Consultant/Advisory Board (Ongoing); Eisai, Inc.: Speaker (Ongoing); Merck: Speaker (Ongoing)

Anita Chen, MD: No financial relationships to disclose

Anne G. Sammarco, MD, MPH: No financial relationships to disclose

David Sheyn, MD: Axonics: Clinical Trial Investigator (Ongoing); Caldera Medical: Advisor (Ongoing), Advisor (Ongoing), Advisor (Ongoing); CollaMedix: Consultant/Advisory Board (Ongoing), Stock-privately held company (Ongoing); Medtronic: Clinical Trial Investigator (Ongoing); Renalis: Clinical Trial Investigator (Ongoing), Clinical Trial Investigator (Ongoing), Clinical Trial Investigator (Ongoing)

Brief

Description:
Our work examined the cost differences associated with various surgical approaches for hysterectomy procedures in the United States. Based on a cross-sectional, retrospective study using data from 2012-2015, our research highlights the importance of understanding the financial implications of different hysterectomy routes. Overall, our findings revealed that vaginal hysterectomy is associated with the lowest median cost nationwide, while robotic hysterectomy incurs the highest cost. The study also explores the impact of demographic factors, concomitant procedures, indications, and geographic region on total hysterectomy costs. With the aim of reducing healthcare spending, our presentation will emphasize the need for surgeons and patients to be aware of cost disparities among surgical approaches, particularly promoting incentives for vaginal hysterectomy as a cost-effective option. Critically, by addressing the identified factors, policymakers can work towards achieving more sustainable healthcare expenditures.

Abstract:

The U.S. spends more on healthcare than any other country globally and is projected to reach $5.7 trillion USD by 2026, increasing at a faster rate than the U.S. GDP. This rate of increase in healthcare spending can have downstream consequences, including higher health insurance premiums and out-of-pocket costs, posing a potential threat to the national economy.

Hysterectomies are among the most commonly performed surgeries in the U.S., and there are several routes/methods providers use to perform them. To reduce healthcare spending, it's crucial for surgeons and patients to be aware of costs associated with different procedural approaches. Therefore, we studied cost differences between hysterectomy routes.

Methods: For our cross-sectional, retrospective study, we used data from the 2012-2015 National Inpatient Sample of Health Care Utilization Project (HCUP-US) We included women ≥18 years old who underwent hysterectomy for benign indications, and hospital charges were converted to actual costs using cost-to-charge ratios provided by HCUP-US. We conducted a multivariate regression analysis to assess the relationship between the type of hysterectomy approach, demographic factors, concomitant procedures, indications, and geographic region with total hysterectomy procedure cost.

Results: Within our total sample population of 150,032 female patients, the nationwide median adjusted cost of hysterectomy (all types) was determined to be $8,251.Vaginal hysterectomy had the lowest median cost nationwide ($7,002, IQR $5,205–9,517), while robotic hysterectomy had the highest median cost nationwide ($10,582, IQR $8,086–14,275).

All other routes of hysterectomy showed increased odds in median cost when compared to median cost of vaginal hysterectomy; abdominal hysterectomy (adjusted OR 1.24, 95% CI 1.18–1.30), laparoscopic hysterectomy (adjusted OR 4.82, 95% CI 4.54–5.11), laparoscopic-assisted vaginal hysterectomy (adjusted OR 3.81, 95% CI 3.60–4.03), and robotic hysterectomy (adjusted OR 8.59, 95% CI 8.12–9.09).

Uterine fibroids were the most common indication for hysterectomy of any type (39.7%). The median cost of hysterectomies conducted for management of pelvic organ prolapse showed greater odds of higher than the adjusted median nationwide cost (all types of hysterectomies) (adjusted odds ratio 1.79, 95% CI 1.70–1.89) when compared to median cost to those who had a hysterectomy procedure for uterine fibroids.

All concomitant procedures were associated with increased cost; concomitant anti-incontinence procedures had the highest likelihood of increased cost (adjusted odds ratio 2.98, 95% CI 2.65–3.34).

Conclusions: Our findings show the route of hysterectomy is an independent significant determinant of costs for the procedure. Vaginal hysterectomy is associated with the lowest cost compared to all other routes. If lowering the cost of healthcare is of value to healthcare policymakers, more incentives should be directed towards vaginal hysterectomy to achieve that important goal.