Surgical approach largest predictor of cost with outpatient hysterectomy in US

Key takeaways :

• Costs were highest for robotic hysterectomy and lowest for vaginal hysterectomy.
• Unobserved differences between surgeons accounted for 60.5% of cost differences.

In the U.S., surgical approach was the single strongest predictor of total costs for an outpatient hysterectomy for benign indications, according to study results published in Obstetrics & Gynecology.

“In our study, across a large nationwide sample of outpatient benign hysterectomies, the variance in cost was strongly influenced by surgical approach and technique/supply differences between surgeons, neither of which are likely to be associated with large differences in quality,” James L. Whiteside, MD, MA, MHA, FACOG, FACS, professor and chair in the department of obstetrics and gynecology and the department of pediatrics at the Brody School of Medicine at East Carolina University, Greensville, North Carolina, told Healio. “It has been previously shown that the surgical robot does not improve care outcomes in the setting of benign hysterectomy over alternative minimally invasive approaches but does increase care costs.”

Researchers analyzed data from a sample of 264,717 women who underwent outpatient hysterectomy for benign conditions performed by 5,153 surgeons from October 2015 to December 2021. The primary outcome was total direct hysterectomy cost. Researchers also assessed patient, hospital and surgeon factors to identify unobserved differences influencing cost variation.

The median total direct cost of hysterectomy was $4,705. Costs were highest for robotic hysterectomy compared with the lowest observed for vaginal hysterectomy ($5,412 vs. $4,147). When including all variables, researchers noted that surgical approach was the strongest predictor of total costs, but 60.5% of cost variance was attributable to unexplained surgeon-level differences, which suggest differences in costs between the 10th and 90th percentiles of surgeons of $4,063.

According to Whiteside, on a policy level, physician reimbursement should be tied to the cost and quality efficiency delivered and care bundles, pay-for-performance, etc, are largely unused in the context of hysterectomy despite it being a common procedure. On the patient level, Whiteside noted, patients should have a greater awareness of care costs relative to quality and overall outcome.

“OB/GYN residency training should immediately focus on high-value surgical approaches. Part of why hysterectomy costs have gone up over the years has been the drift from vaginal hysterectomy to laparoscopic or robotic hysterectomy. The implications for this have been significant,” Whiteside said. “Rural hospitals without a robot now have trouble recruiting OB/GYNs, as many residents coming out of training do not possess the interest or skill to perform gynecologic surgery without the surgical robot.”

For more information:

James L. Whiteside, MD, MA, MHA, FACOG, FACS, can be reached at whitesideja21@ecu.edu.