Affiliation:
1. Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Germany
2. Asklepios Harzklinik Goslar, Klinik für Frauenheilkunde und Geburtshilfe, Goslar, Germany
Abstract
Abstract
Objective The LACC (Laparoscopic Approach to Cervical Cancer) study revealed advantages in terms of overall survival and relapse risk favouring abdominal radical hysterectomy over the laparoscopic procedure. The present paper will compare the two surgical techniques from the economic point of view based on a process cost calculation.
Material/Methods A retrospective cost analysis of all radical hysterectomies from the year 2018 was done at the Hanover University Medical School based on the bottoms-up method and guided by the clinical treatment pathway.
Result Of 51 primary cases treated, 19 patients underwent radical hysterectomies, of which 8 were performed using the abdominal technique and 11 as endoscopic surgeries. 89.4% of the cancers were FIGO IB1 carcinomas. The total cost of a laparoscopic radical hysterectomy with an average hospital stay of 4.6 days came to € 2512.34, compared to an abdominal radical hysterectomy at € 2586.78 with an average hospital stay of 7.6 days. The greatest cost factor in which the laparoscopic method exceeded abdominal radical hysterectomy was the surgical procedure itself (€ 1836.75 vs. € 1411.21). Personnel represented the largest cost item in the surgical theatre (59%), so that surgery time was a significant multiplying factor. Average surgical time required for abdominal radical hysterectomy was 154 minutes, whereby the laparoscopic procedure required an average of 220.1 minutes. Inpatient care in the abdominal radical procedure cases was more costly by € 499.98 due to the
longer hospitalization and additional medication required. Profit levels, including the DRG revenues, were higher with the abdominal method than with the laparoscopic method by € 186.21 despite longer hospital stays.
Conclusion The present paper shows slightly greater profitability for the abdominal radical hysterectomy. On the other hand, this method entails longer hospitalization and a higher level of personnel deployment. Adequate occupancy management could make up for the revenue shortfall observed with the laparoscopic method.
Subject
Maternity and Midwifery,Obstetrics and Gynecology
Reference14 articles.
1. Minimally Invasive versus Abdominal Radical Hysterektomie for Cervical Cancer;P T Ramirez;N Engl J Med,2018
2. Stellungnahme zur LACC-Studie bei frühem Zervixkarzinom der Kommission Uterus der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) und der Arbeitsgemeinschaft Gynäkologische Endoskopie (AGE) der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG);P Hillemanns;Geburtshilfe Frauenheilkd,2018
3. Radical hysterectomy for early cervical cancer: what shall we do after the LACC trial?;P Hillemanns;Arch Gynecol Obstet,2020
4. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial;T E Nieboer;Obstet Gynecol,2012
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
1. Urological Complications in Total Laparoscopic Hysterectomy (TLH);Complex Total Laparoscopic Hysterectomy (TLH) with Newer Approaches in Bladder Dissection;2024