Open Abdominal versus Laparoscopic and Vaginal Hysterectomy: Analysis of a Large United States Payer Measuring Quality and Cost of Care

Abstract Objective To compare minimally invasive procedures (MIP)—laparoscopic and vaginal hysterectomy with the traditional open abdominal hysterectomy method by evaluating clinical and economic outcomes and use. Methods A retrospective analysis was performed with deidentified claims data and enrollment information from a large U.S. managed care plan. 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. Bivariate comparisons between MIP and open abdominal procedures used t -tests for continuous variables and χ2 tests for proportions. The predicted generalized linear modeling regression equation evaluated the effect of procedures on expenditures. Results Of 15 404 patients, MIP was performed in 43% of subjects, with 23% (3520) undergoing laparoscopic hysterectomy, and 20% (3130) a vaginal hysterectomy. Postoperative infection rates were higher for patients undergoing open abdominal hysterectomy: 18% as compared with 15% of laparoscopic and 14% of patients undergoing vaginal hysterectomy ( P