Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Cost-effectiveness of laparoscopic hysterectomy: the effect of length of hospital stay
- Jason E Dodge (28 February 2004)
|
|
|||
|
Jason E Dodge, University of Toronto 2075 Bayview Ave., Toronto, Ontario, M4N 3M5
Send response to journal:
|
I congratulate the authors on two well-performed studies. This data is obviously important for gynecologic surgeons to permit informed decisions regarding the benefits of the various surgical modalities available for performing hysterectomy for patients with benign gynecologic conditions. However, my major concern with the authors' analysis of the cost- effectiveness data is that the length of post-operative hospital stay (LOS) seems excessive in both studies. Patients had a median LOS of at least 4 days in all three "minimally-invasive" hysterectomy arms, whereas those who underwent abdominal hysterectomy had a median LOS of 5 days. I would suggest that this excessive post-operative hospital stay is responsible for the negative result of the studies in terms of cost- effectiveness of these less invasive modalities. Did the results of the sensitivity analysis alluded to in the paper confirm this possibility? Clearly, the total cost of any procedure is largely influenced by the LOS. In our unit, patients undergoing vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy (simple or radical) are ROUTINELY discharged from hospital the day after surgery, whereas patients undergoing an abdominal hysterectomy have a median LOS of 4 days. We feel that this early discharge IS the benefit of laparoscopic surgery in comparison to traditional access surgery (which is otherwise faster and less technologically complex!). Otherwise, as demonstrated by Sculpher et al., there is unlikely to be a cost-savings, and therefore little reason to pursue laparoscopic surgery. Competing interests: None declared |
|||