No Savings with Less Invasive Hysterectomy

A rapid transition from open to minimally invasive surgery for hysterectomy failed to reduce costs at one large medical center, investigators reported here.

Over a 4-year period, the proportion of minimally invasive procedures increased from fewer than 10% to almost two-thirds of all hysterectomies performed at the center.

The per-procedure cost of minimally invasive hysterectomies also increased, and by the end of the 4 years, a minimally invasive procedure cost about the same as an open procedure had cost at the beginning of the transition, according to Neel Shah, MD, of Massachusetts General Hospital in Boston.

Much of the added cost came from longer operating times, as the mean duration of minimally invasive procedures increased by more than 50%, he reported at the Society of Gynecologic Oncology meeting.

“Even though there was a seven-fold increase in minimally invasive surgery, it ends up being a wash in terms of cost,” said Shah. “The hospital doesn’t realize any of the cost benefits.”

“This represents a significant financial risk for the provider. A longer time in the operating room combined with earlier discharge means that the hospital is less likely to regain any of that cost.”

Nationwide, hysterectomy accounts for an estimated $350 million annually in healthcare costs. The figure will likely continue to increase well into the future, given current trends in obesity (a major risk for endometrial dysplasia and cancer) and the aging population, said Shah.

Minimally Invasive Surgery has a variety of patient benefits:

Less pain
Shorter hospital stay
Faster recovery time
Smaller scar

Minimally invasive surgery involves the use of instruments inserted through small incisions. These incisions enable fiber optic tubes, connected to television monitors, to be inserted into the patient, allowing doctors to perform surgical procedures without making large incisions.

The introduction of laparoscopic surgical technology has provided a means to control and perhaps reduce costs associated with hysterectomy. High-quality clinical evidence has demonstrated that laparoscopic surgery has had a “clear and positive impact in terms of getting people home sooner, recovering faster, and returning to work and normal activities sooner,” said Shah.

The extent to which hospitals might have realized any of the cost-saving potential of minimally invasive surgery has not been studied extensively. With that in mind, Shah and colleagues examined medical records for patients who underwent hysterectomy at Massachusetts General Hospital from 2006 through 2009.

The time period included in the analysis encompassed a rapid paradigm shift from open to laparoscopic hysterectomy, said Shah. Of 452 hysterectomies performed during the period, laparoscopic surgery accounted for about 7% of the procedures in 2006 but almost 63% by the start of 2010.

If you’re weighing the important decision of hysterectomy – the surgical removal of the uterus and sometimes ovaries and fallopian tubes – you may want to consider a gentler method called minimally invasive hysterectomy. Minimally invasive (laparoscopic) hysterectomy treats conditions like fibroids, endometriosis and uterine prolapse.

Clovis Community Medical Center’s minimally invasive hysterectomy program is specifically focused on using minimally invasive techniques for hysterectomies and related women’s surgeries.

As a whole, 93% of the hysterectomies through our program are performed laparoscopically compared to the national average of about 50%.

Investigators used actual hospital costs calculated by the hospital and then adjusted for inflation to reflect costs in terms of 2010 dollars.

In 2006 the cost of a laparoscopic hysterectomy averaged $13,211, versus $15,000 to $16,000 for open surgery. By the end of 2009 the cost of a laparoscopic hysterectomy had increased to $16,017.

“For each year, the cost of a laparotomy also increased, but by 2010 the proportion of patients restricted to laparotomy was the most difficult and complicated cases we had,” said Shah.

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