Comparative Study of Vaginal,Abdominal,and Robotic Laparoscopic Hysterectomy: Clinical Outcome and Cost

Abstract

Abstract

Objective: To compare the effects of different hysterectomy methods on the length of hospital stay, postoperative outcome, and total hospital charges. Design: This is a retrospective clinical study of patients from the author's practice. Methods: Data were collected from the office and hospital electronic medical records (EMR), and questionnaires were used to determine patient's postoperative outcome. Patients were divided into three surgical groups: total vaginal hysterectomy (TVH), total abdominal hysterectomy (TAH), and robotic laparoscopic hysterectomy (RLH). Exactly 211 patients were reviewed, but only 203 had completed medical records. Of those, exactly 140 patient questionnaires were completed. Results: A retrospective study of all consecutive hysterectomy cases from January 1, 2008, to July 31, 2008, was performed. Patient's office and hospital EMRs were used to determine patient demographics, length of hospital stay, operative time, estimated blood loss (EBL), and total hospital charges. TAH was found to have a significantly higher hospital stay of 2.88 days, compared to TVH with 1.66 days and RLH with 1.39 days. RLH had a significantly higher operative time than TVH and TAH. There were no significant differences in hospital charges between RLH and TAH, but both TAH and RH had significantly higher total charges than TVH. In addition, TAH had a higher reported postoperative pain level than TVH and RLH. TAH had a significant higher EBL than RLH, but there was no significant difference in EBL for other methods. Conclusion: Our study reveals a significant difference in the length of hospital stay in TAH versus all other hysterectomy methods. TAH and RLH have a significant difference in hospital charges versus TVH, while there was no significant difference between TAH and RLH hospital charges. TAH had a higher level of postoperative pain than RLH and TVH. (J GYNECOL SURG 31:260)