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Resource Use for Total and Supracervical Hysterectomies: Results of a Randomized Trial

Jonathan Showstack, PhD, MPH^*, Miriam Kuppermann, PhD, MPH, Feng Lin, MS, Eric Vittinghoff, PhD, R Edward Varner, MD^¶, Robert L. Summitt, Jr, MD^||, S Gene McNeeley, MD^*, Lee A. Learman, MD, PhD, Holly Richter, PhD, MD^¶, Stephen Hulley, MD, MPH and A Eugene Washington, MD, MSc^*¶||*

From the Departments of *Medicine, Obstetrics, Gynecology and Reproductive Sciences, Epidemiology and Biostatistics, and Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, California; ¶University of Alabama, Birmingham, Alabama; ||University of Tennessee, Memphis, Tennessee; and *Wayne State University, Detroit, Michigan.

OBJECTIVE: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the "TOSH" trial). We report here an analysis of 24-month resource use by patients in this trial.

METHODS: A randomized controlled trial was performed at 3 clinical centers to compare resources used by 120 patients who received a total or supracervical abdominal hysterectomy. Service use during a 24-month follow-up period was identified from medical and billing records and patient reports. Each service used was assigned a relative value, which was then converted into 2002 U.S. dollars.

RESULTS: Overall resource use was similar in the 2 study groups in the first 12 months after randomization (TAH $5,870; SCH $6,018; 95% confidence interval for difference –$960, $1,255; P < .79) and for the full 24 months (TAH $6,448; SCH $7,479; 95% confidence interval for difference –$533, $2,616; P < .20). In exploratory multivariable analyses, resource use was significantly associated with baseline body mass index greater than or equal to 35 kg/m² ($8,440 versus $6,398, P = .02) and heavy bleeding ($7,550 versus $5,368, P = .02).

CONCLUSION: We conclude that the use of medical care resources over a 24-month period is comparable for total and supracervical hysterectomy. The association of a woman’s weight and bleeding pattern with subsequent resource use requires further investigation.

LEVEL OF EVIDENCE: I

This article has been cited by other articles:

				M. Kuppermann, R. L. Summitt Jr, R. E. Varner, S. G. McNeeley, D. Goodman-Gruen, L. A. Learman, C. C. Ireland, E. Vittinghoff, F. Lin, H. E. Richter, et al. Sexual Functioning After Total Compared With Supracervical Hysterectomy: A Randomized Trial Obstet. Gynecol., June 1, 2005; 105(6): 1309 - 1318. [Abstract] [Full Text] [PDF]