Hysterectomy is the most common non-obstetrical surgical procedure among women; however, little research has been done on the variation of hospital costs for the procedure.METHODS:
We conducted a retrospective cohort study from the National Inpatient Sample (NIS) database. Patients undergoing hysterectomy for benign gynecological disease during 2012 were identified. Variations in facility costs were calculated for hospitalizations of hysterectomies. Hospital characteristics were tested for associations with increased hospitalization cost.RESULTS:
A total of 263,040 hospitalizations for hysterectomy were identified. Hospital cost per hysterectomy ranged from $4,611 to $15,748 (median: $7,974) between the 10th and 90th percentiles. This demonstrates a 3.4 fold difference in overall cost. Vaginal hysterectomies incurred the least cost and ranged from $3,866–$12,422 (median: $6,718). Abdominal hysterectomies ranged from $4,564–$16,067 (median: $7,626). Laparoscopic hysterectomies incurred the greatest cost and ranged from $5,533–$16,828 (median: $9,228). Hospital costs were highest in the West and lowest in the Northeast with a 41% difference ($10,860 vs $7,719, P=<.001). Rural costs were 11% higher than urban non-teaching centers ($9,640 vs $8,684, P=<.001), government facilities cost 8% more than private investor-owned facilities ($9,300 vs $8,622, P=<.001), and smaller hospitals cost 16% more than the larger hospitals ($9,819 vs $8,480, P=<.001).CONCLUSION:
There is large variation in hospital cost for hysterectomies completed for benign indications in the US. Increased costs are associated with rural, government sponsored, and small hospitals. Hospital practices may be an important contributor and could represent an area of opportunity for cost reduction in the US.