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Obstetrics & Gynecology 2006;107:1057-1063
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Factors Associated With Increased Charges for Hysterectomy

Kristen A. Matteson, MD1, Jeffrey F. Peipert, MD, MPH1, Priya Hirway, MS1, Kristen Cotter, MD, MPH1, Andrea J. DiLuigi, MD1 and Roxanne M. Jamshidi, MD1

From the 1Division of Research and the George Anderson Outcomes Unit, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown Medical School, Providence, Rhode Island.

OBJECTIVE: To evaluate factors associated with increased hospital charges for hysterectomy with specific attention to differences based on surgical approach.

METHODS: We performed a retrospective cohort study of 686 patients who underwent hysterectomy between January 1997 and September 1997 using medical chart review and hospital financial information. Demographic information, surgical approach (abdominal, vaginal, or laparoscopic), and surgical and postoperative factors were extracted from the medical record. Hospital charges were obtained from the hospital billing database. Relationships between charges and various clinical and demographic variables were examined using {chi}2, Fisher exact test, t tests, or analysis of variance, where appropriate. Logistic regression was used to estimate odds ratios while controlling for important confounding variables.

RESULTS: In our logistic regression model, blood loss greater than 1,000 mL (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.2–33.2) and operative time 105 minutes or more (OR 14.2, CI 5.8–34.5) were strongly associated with higher charges for hysterectomy. Other factors associated with higher charges included: postoperative fever (OR 2.2, CI 1.1–4.5), increasing length of hospitalization (OR 5.3, CI 3.7–7.7), the use of prophylactic antibiotics (OR 3.0, CI 1.3–6.6), and the laparoscopic surgical approach compared with vaginal hysterectomy (OR 2.7, CI 1.0–7.0).

CONCLUSION: Surgical factors such as operative time and blood loss were strongly associated with increased hospital charges for hysterectomy.

LEVEL OF EVIDENCE: II-2






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