Without contraindications, elect minimally invasive, not abdominal, hysterectomy

Laparoscopic or vaginal hysterectomy results in fewer postoperative infections, shorter hospital stays, and greater cost savings compared with traditional open abdominal hysterectomy, according to a retrospective analysis performed on claims data and enrollment information from a large United States managed care plan.

Of 15,404 women included in the data, 23% received laparoscopic hysterectomy, 20% received a vaginal hysterectomy, and the remainder received traditional open abdominal surgery. Postoperative infections developed in 18% of the abdominal group, 15% of the laparoscopic group, and 14% of the vaginal group (p<.05). Mean length of hospital stay was 3.7 days for the abdominal group versus 1.6 days for the laparoscopic group and 1.5 days for the vaginal group (p<.001 for both).

Mean unadjusted expenditures for the women in the abdominal group, the laparoscopic group, and the vaginal group were $12,086, $10,868, and $9,544, respectively (p<.05); however, when expenditures were adjusted for differences in patient mix, no difference existed between the laparoscopic and abdominal groups, although a significant difference (p<.05) remained between the vaginal and abdominal groups, with the former costing a mean of $1,270 less.