Resource use for total and supracervical hysterectomies: Results of a randomized trial

Jonathan Showstack, Miriam Kuppermann, Feng Lin, Eric Vittinghoff, R. Edward Varner, Robert L. Summitt, S. Gene McNeeley, Lee A. Learman, Holly Richter, Stephen Hulley, A. Eugene Washington

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the "TOSH" trial). We report here an analysis of 24-month resource use by patients in this trial. METHODS: A randomized controlled trial was performed at 3 clinical centers to compare resources used by 120 patients who received a total or supracervical abdominal hysterectomy. Service use during a 24-month follow-up period was identified from medical and billing records and patient reports. Each service used was assigned a relative value, which was then converted into 2002 U.S. dollars. RESULTS: Overall resource use was similar in the 2 study groups in the first 12 months after randomization (TAH $5,870; SCH $6,018; 95% confidence interval for difference -$960, $1,255; P <.79) and for the full 24 months (TAH $6,448; SCH $7,479; 95% confidence interval for difference -$533, $2,616; P <.20). In exploratory multivariable analyses, resource use was significantly associated with baseline body mass index greater than or equal to 35 kg/m2 ($8,440 versus $6,398, P = .02) and heavy bleeding ($7,550 versus $5,368, P = .02). CONCLUSION: We conclude that the use of medical care resources over a 24-month period is comparable for total and supracervical hysterectomy. The association of a woman's weight and bleeding pattern with subsequent resource use requires further investigation.

Original languageEnglish (US)
Pages (from-to)834-841
Number of pages8
JournalObstetrics and Gynecology
Volume103
Issue number5 I
DOIs
StatePublished - May 2004
Externally publishedYes

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Hysterectomy
Randomized Controlled Trials
Confidence Intervals
Hemorrhage
Random Allocation
Cervix Uteri
Medical Records
Body Mass Index
Weights and Measures

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Showstack, J., Kuppermann, M., Lin, F., Vittinghoff, E., Varner, R. E., Summitt, R. L., ... Washington, A. E. (2004). Resource use for total and supracervical hysterectomies: Results of a randomized trial. Obstetrics and Gynecology, 103(5 I), 834-841. https://doi.org/10.1097/01.AOG.0000124273.76992.73

Resource use for total and supracervical hysterectomies : Results of a randomized trial. / Showstack, Jonathan; Kuppermann, Miriam; Lin, Feng; Vittinghoff, Eric; Varner, R. Edward; Summitt, Robert L.; McNeeley, S. Gene; Learman, Lee A.; Richter, Holly; Hulley, Stephen; Washington, A. Eugene.

In: Obstetrics and Gynecology, Vol. 103, No. 5 I, 05.2004, p. 834-841.

Research output: Contribution to journalArticle

Showstack, J, Kuppermann, M, Lin, F, Vittinghoff, E, Varner, RE, Summitt, RL, McNeeley, SG, Learman, LA, Richter, H, Hulley, S & Washington, AE 2004, 'Resource use for total and supracervical hysterectomies: Results of a randomized trial', Obstetrics and Gynecology, vol. 103, no. 5 I, pp. 834-841. https://doi.org/10.1097/01.AOG.0000124273.76992.73
Showstack J, Kuppermann M, Lin F, Vittinghoff E, Varner RE, Summitt RL et al. Resource use for total and supracervical hysterectomies: Results of a randomized trial. Obstetrics and Gynecology. 2004 May;103(5 I):834-841. https://doi.org/10.1097/01.AOG.0000124273.76992.73
Showstack, Jonathan ; Kuppermann, Miriam ; Lin, Feng ; Vittinghoff, Eric ; Varner, R. Edward ; Summitt, Robert L. ; McNeeley, S. Gene ; Learman, Lee A. ; Richter, Holly ; Hulley, Stephen ; Washington, A. Eugene. / Resource use for total and supracervical hysterectomies : Results of a randomized trial. In: Obstetrics and Gynecology. 2004 ; Vol. 103, No. 5 I. pp. 834-841.
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abstract = "OBJECTIVE: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the {"}TOSH{"} trial). We report here an analysis of 24-month resource use by patients in this trial. METHODS: A randomized controlled trial was performed at 3 clinical centers to compare resources used by 120 patients who received a total or supracervical abdominal hysterectomy. Service use during a 24-month follow-up period was identified from medical and billing records and patient reports. Each service used was assigned a relative value, which was then converted into 2002 U.S. dollars. RESULTS: Overall resource use was similar in the 2 study groups in the first 12 months after randomization (TAH $5,870; SCH $6,018; 95{\%} confidence interval for difference -$960, $1,255; P <.79) and for the full 24 months (TAH $6,448; SCH $7,479; 95{\%} confidence interval for difference -$533, $2,616; P <.20). In exploratory multivariable analyses, resource use was significantly associated with baseline body mass index greater than or equal to 35 kg/m2 ($8,440 versus $6,398, P = .02) and heavy bleeding ($7,550 versus $5,368, P = .02). CONCLUSION: We conclude that the use of medical care resources over a 24-month period is comparable for total and supracervical hysterectomy. The association of a woman's weight and bleeding pattern with subsequent resource use requires further investigation.",
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AU - Lin, Feng

AU - Vittinghoff, Eric

AU - Varner, R. Edward

AU - Summitt, Robert L.

AU - McNeeley, S. Gene

AU - Learman, Lee A.

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AU - Hulley, Stephen

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