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Cost Differences Among Robotic, Vaginal, and Abdominal Hysterectomy

Woelk, Joshua L. MD; Borah, Bijan J. PhD; Trabuco, Emanuel C. MD; Heien, Herbert C.; Gebhart, John B. MD

doi: 10.1097/AOG.0000000000000090
Contents: Original Research

OBJECTIVE: To compare the costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy.

METHODS: We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at the Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score-matched (one-to-one) to cases of vaginal and abdominal hysterectomy, selected randomly from January 1, 2004, through December 31, 2006 (before acquisition of the robotic surgical system). All billed costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were estimated.

RESULTS: The total number of abdominal hysterectomies collected for comparison was 234 and the total number of vaginal hysterectomies was 212. Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 compared with $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted compared with abdominal hysterectomy were similar ($14,679 compared with $15,588; P=.35). The costs of complications were not significantly different.

CONCLUSIONS: Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs.


Vaginal hysterectomy is least costly, whereas robotically assisted hysterectomy and abdominal hysterectomy costs are similar.Supplemental Digital Content is Available in the Text.

Urogynecology and Continence Center, Methodist Physicians Clinic, Omaha, Nebraska; and the Divisions of Health Care Policy and Research and Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.

Corresponding author: John B. Gebhart, MD, Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail:

Study data were obtained from the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01 AG034676. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.