Comparative morbidity and charges associated with route of hysterectomy and concomitant Burch colposuspension

OBJECTIVE: To compare the surgical morbidity, postoperative course, and hospital charges of Burch colposuspension performed in conjunction with abdominal versus vaginal hysterectomy. METHODS: Power analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a beta error of 20% and an alpha error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight, and operative and total hospital charges were obtained for each group. RESULTS: There was no statistically significant difference in demographics, surgical history, postoperative hemoglobin and hematocrit decrease, postoperative complications (10 versus 23%), operative charges ($4417 +/- 1200 versus $4731 +/- 1453), mean uterine weight (113.5 +/- 45 versus 125.8 +/- 45 g), and operative times (3.0 +/- 0.8 versus 2.9 +/- 0.7 hours) between the vaginal and abdominal groups, respectively. A post hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for postoperative complication rates. The abdominal group had significantly longer hospital stays (3.1 +/- 1.0 versus 2.6 +/- 0.7 days) and higher charges ($7337 +/- 1828 versus $6342 +/- 1123) than the vaginal group. CONCLUSION: When hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate.