Cargando…
Value‐based assessment of hysterectomy approaches
AIM: By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of th...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons Australia, Ltd
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587959/ https://www.ncbi.nlm.nih.gov/pubmed/30402927 http://dx.doi.org/10.1111/jog.13853 |
_version_ | 1783429175506370560 |
---|---|
author | Danilyants, Natalya MacKoul, Paul Baxi, Rupen van der Does, Louise Q. Haworth, Leah R. |
author_facet | Danilyants, Natalya MacKoul, Paul Baxi, Rupen van der Does, Louise Q. Haworth, Leah R. |
author_sort | Danilyants, Natalya |
collection | PubMed |
description | AIM: By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. METHODS: Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. RESULTS: Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. CONCLUSION: Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value. |
format | Online Article Text |
id | pubmed-6587959 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley & Sons Australia, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-65879592019-07-02 Value‐based assessment of hysterectomy approaches Danilyants, Natalya MacKoul, Paul Baxi, Rupen van der Does, Louise Q. Haworth, Leah R. J Obstet Gynaecol Res Original Articles AIM: By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. METHODS: Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. RESULTS: Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. CONCLUSION: Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value. John Wiley & Sons Australia, Ltd 2018-11-06 2019-02 /pmc/articles/PMC6587959/ /pubmed/30402927 http://dx.doi.org/10.1111/jog.13853 Text en © 2018 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Danilyants, Natalya MacKoul, Paul Baxi, Rupen van der Does, Louise Q. Haworth, Leah R. Value‐based assessment of hysterectomy approaches |
title | Value‐based assessment of hysterectomy approaches |
title_full | Value‐based assessment of hysterectomy approaches |
title_fullStr | Value‐based assessment of hysterectomy approaches |
title_full_unstemmed | Value‐based assessment of hysterectomy approaches |
title_short | Value‐based assessment of hysterectomy approaches |
title_sort | value‐based assessment of hysterectomy approaches |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587959/ https://www.ncbi.nlm.nih.gov/pubmed/30402927 http://dx.doi.org/10.1111/jog.13853 |
work_keys_str_mv | AT danilyantsnatalya valuebasedassessmentofhysterectomyapproaches AT mackoulpaul valuebasedassessmentofhysterectomyapproaches AT baxirupen valuebasedassessmentofhysterectomyapproaches AT vanderdoeslouiseq valuebasedassessmentofhysterectomyapproaches AT haworthleahr valuebasedassessmentofhysterectomyapproaches |