Hospital costs of total vaginal hysterectomy compared with other minimally invasive hysterectomy

OBJECTIVE: The objective of the study was to determine total hospital costs and net hospital income for different types of minimally invasive hysterectomy and financial impact if a subset of patients underwent total vaginal hysterectomy (TVH) instead of their selected procedure. STUDY DESIGN: A retrospective chart review was performed of patients who underwent hysterectomy for benign disease by TVH, laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), and robotic hysterectomy (RH) between Jan. 1, 2007, and April 30, 2010, at Thomas Jefferson University Hospital. The hospital decision support database was used to calculate net hospital income. A subset of patients with at least 1 prior vaginal delivery, no more than 1 laparotomy, and a uterine size less than 14 weeks who had undergone RH, TLH, or LAVH was identified as potential TVH candidates. The financial impact of performing TVH over the selected hysterectomy was calculated. RESULTS: Three hundred thirty-four cases of minimally invasive hysterectomy were identified. Fifty-five percent were TVH, 33% LAVH, 3% TLH, and 9% RH. Mean total hospital costs for TVH were $7903, $10,069 for LAVH, $11,558 for TLH, and $13,429 for RH (P<.0001). Net hospital income was $1260 for TVH. The hospital incurred losses of $e1306 for LAVH, $e4049 for TLH, and $e4564 for RH (P = .03). Our criteria to determine the mode of hysterectomy increased TVH from 57% to 76% of all minimally invasive hysterectomy. CONCLUSION: Hospital costs were greater with LAVH, TLH, and RH than for TVH. The hospital incurred financial losses with LAVH, TLH, and RH. TVH was the only minimally invasive modality of hysterectomy that generated net hospital income. Our conservative criteria to determine the route of hysterectomy would increase the number of TVHs by more than 30%.