CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(10): 1154-1160
DOI: 10.1055/a-1500-8056
GebFra Science
Original Article/Originalarbeit

Abdominal and Laparoscopic Cervical Carcinoma Therapy – a Comparative Economic Assessment

Article in several languages: English | deutsch
Lars Brodowski
1   Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Germany
,
Matthias Jentschke
1   Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Germany
,
Hermann Hertel
1   Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Germany
,
Peter Hillemanns
1   Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Germany
,
Fabian Kohls
2   Asklepios Harzklinik Goslar, Klinik für Frauenheilkunde und Geburtshilfe, Goslar, Germany
› Author Affiliations
› Further Information
   Permissions and Reprints

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.

Key words

cervical carcinoma - radical hysterectomy - process cost calculation


Publication History

Received: 06 September 2020

Accepted after revision: 05 May 2021

Article published online:
06 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Ramirez PT, Frumovitz M, Pareja R. et al. Minimally Invasive versus Abdominal Radical Hysterektomie for Cervical Cancer. N Engl J Med 2018; 379: 1895-1904
    CrossrefPubMedGoogle Scholar
  • 2 Hillemanns P, Bruckers S, Holthaus B. et al. 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). Geburtshilfe Frauenheilkd 2018; 78: 766-767
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Hillemanns P, Hertel H, Klapdor R. Radical hysterectomy for early cervical cancer: what shall we do after the LACC trial?. Arch Gynecol Obstet 2020; 302: 289-292 DOI: 10.1007/s00404-020-05627-x.
    CrossrefPubMedGoogle Scholar
  • 4 Mayer R, Weich M. Steuerung der Kunden- und Produktprofitabilität. In: Prozesskostenmanagement umsetzen. Stuttgart: Horváth & Partner; 2005: 141-158
    Google Scholar
  • 5 Nieboer TE, Hendriks JC, Bongers MY. et al. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial. Obstet Gynecol 2012; 119: 85-91
    CrossrefPubMedGoogle Scholar
  • 6 Schneider A, Possover M, Kühne-Heid R. et al. Laparoskopische paraaortale und pelvine Lymphonodektomie. Gynäkologe 1997; 30: 483-499
    CrossrefGoogle Scholar
  • 7 Martin J, Kuhlen R, Kastrup M. et al. Die Standard-operating-procedures-Tauschbörse Anästhesiologie, Intensivmedizin, Schmerztherapie und Notfallmedizin. Anaesthesist 2005; 54: 495-496
    CrossrefPubMedGoogle Scholar
  • 8 Hertel H, Köhler C, Michels W. et al. Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 2003; 90: 505-511
    CrossrefPubMedGoogle Scholar
  • 9 Myers JN, Fonda H. The impact of fitness on surgical outcomes: the case for prehabilitation. Curr Sports Med Rep 2016; 15: 282-289
    CrossrefPubMedGoogle Scholar
  • 10 Le Roy B, Pereira B, Bouteloup C. et al. Effect of prehabilitation in gastro-oesophageal adenocarcinoma: study protocol of a multicentric, randomised, control trial – the PREHAB study. BMJ Open 2016; 6: e012876
    CrossrefPubMedGoogle Scholar
  • 11 Statistisches Bundesamt. Pressemitteilung Nr. 087 vom 10. Jan. 2021. Online (Stand: 10.01.2021): https://www.destatis.de/DE/Presse/Pressemitteilungen/2019/04/PD19_164_624.html;jsessionid=1CC67E74760633A4CC1FB88B781B2550.internet8721l
    Google Scholar
  • 12 Roeder N, Küttner T. Klinische Behandlungspfade. Mit Standards erfolgreicher arbeiten. Köln: Deutscher Ärzte Verlag; 2007
    Google Scholar
  • 13 Desille-Gbaguidi H, Hebert T, Paternotte-Villemagne J. et al. Overall care cost comparison between robotic and laparoscopic surgery for endometrial and cervical cancer. Eur J Obstet Gynecol Reprod Biol 2013; 171: 348-352
    CrossrefPubMedGoogle Scholar
  • 14 Reynisson P, Persson J. Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy. Gynecol Oncol 2013; 130: 95-99
    CrossrefPubMedGoogle Scholar
  • 15 Wertheim E. Die erweiterte abdominale Operation bei Carcinoma colli uteri (auf Grundlage von 500 Fällen). Berlin: Verlag Urban und Schwarzenberg; 1911
    Google Scholar