Minimally Invasive Hysterectomy Reduces Rates of Postoperative Infection

managed care plan, to compare minimally invasive procedures (MIP) hysterectomy with the traditional open abdominal hysterectomy method, by evaluating clinical and economic outcomes and use. Data were collected on intraoperative and postoperative complications, length of stay, rates of readmission, and insurer and patient payment totals for inpatient and outpatient procedures.

The results showed that MIP were performed in 43% of subjects, with 23% (3,520) undergoing laparoscopic hysterectomy, and 20% (3,130) a vaginal hysterectomy. The postoperative infection rates for patients undergoing open abdominal hysterectomy were 18%, higher than those undergoing laparoscopic (15%) and vaginal hysterectomy (14%). With open abdominal hysterectomy, length of stay was 3.7 days versus 1.6 and 2.2 days, respectively, for patients undergoing MIP laparoscopic and MIP vaginal hysterectomy. Unadjusted expenditures for patients undergoing open abdominal hysterectomy averaged US$12,086, whereas MIP (laparoscopic and vaginal) patients accrued costs of $10,868 and $9544, respectively. When expenditures were adjusted for differences in patient mix, there was no difference for open abdominal hysterectomy versus MIP laparoscopic; however, there were significantly lower expenditures for MIP vaginal versus open abdominal hysterectomy, with a mean difference of $1,270; adjusted expenditures associated with outpatient MIP were markedly lower than expenditures for inpatient open abdominal hysterectomy. The study was published in the September 2009 issue of The Journal of Minimally Invasive Gynecology.

"In this age of comparative effectiveness, this study shows that when it comes to hysterectomy, a minimally invasive approach gives physicians the opportunity to increase the quality of care women are receiving while potentially saving the healthcare system millions of dollars,” said lead author Lori Warren, M.D. "Clinicians who have had concerns that minimally invasive procedures may be riskier for patients should be reassured because this real-world data demonstrates the overall complication rate is actually higher with the open abdominal approach.”

Among the three methods of hysterectomy, open abdominal hysterectomy remains the most common approach as 70 % of all procedures are still performed in this manner, despite the emerging benefits of minimally invasive approaches.

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