Clinical And Health Economics Evaluation Of Abdominal,Vaginal And Laparoscopic Hysterectomies Among Women With Benign Gynecologic Disease

Objective:Retrospective analysis of surgical experience data and health economics comparing different methods of benign hysterectomy including abdominal, vaginal and laparoscopic techniques. Methods:We performed a retrospective cohort analysis of all patients who underwent a hysterectomy for benign reasons in2011and2012at Zhongshan Hospital of Fudan University using the X2test and t test. A multivariate regression analysis was also performed for predictor of costs. Results:In2011and2012,790patients underwent a benign hysterectomy;431(54.56%) hysterectomies were laparoscopic,317(40.13%) abdominal42(5.32%) vaginal. The common indications for surgery included uterine leiomyoma(48.03%), benign ovarian tumor(21.34%), genital prolapsed (7.42%) and adenomyosis(5.57%). Compared to preoperative diagnosis and postoperative pathological results, we calculated diagnostic coincidence rate was87.34%. There were no statistically significant differences in the preoperative hospitalization days and blood transfusion rate. There were statistically significant differences of LAVH group, TAH group and TVH group in the age(52.73vs.52.52vs.67.90, P<0.05), the length of stay(8.22vs.11.07vs.10.07days, P<0.05), the postoperative hospitalization days (4.68vs.7.30vs.5.95days, P<0.05), estimated blood loss (81.57vs.105.89vs.89.29ml, P<0.05) and uterine body diameter (7.45vs.8.68vs.4.48days, P<0.05). Mean total patient costs were16015.58yuan for laparoscopic, and12522.88yuan for abdominal and10684.65yuan for vaginal hysterectomies. The OR costs were6503.04yuan for laparoscopic, and3914.75yuan for abdominal and3916.55yuan for vaginal hysterectomies. Total costs were significantly influenced by method of hysterectomy, OR costs, length of stay and estimated blood loss. Conclusion:The clinical effect of LAVH group is better than the other two groups’. The advantages are less blood loss and a shorter length of hospital stay for qualified patients. The total costs of LAVH group is larger than the others, but it has a better future. Patient costs are significantly influenced by the method of hysterectomy.