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OBJECTIVE: To compare inpatient hospital costs and complication rates within the 90-day global billing period among routes of hysterectomy. METHODS: The Premier Healthcare Database was used to identify patients who underwent hysterectomy between 2000 and 2020. Current Procedural Terminology codes were used to group patients based on route of hysterectomy. Comorbidities and complications were identified using International Classification of Diseases codes. Fixed, variable, and total costs for inpatient care were compared. Fixed costs consist of costs that are set for the case, such as operating room time or surgeon costs. Variable costs include disposable and reusable items that are billed additionally. Total costs equal fixed and variable costs combined. Data were analyzed using analysis of variance, t test, and χ2 test, as appropriate. Factors independently associated with increased total costs were assessed using linear mixed effects models. Multivariate logistic regression was performed to evaluate associations between the route of surgery and complication rates. RESULTS: A cohort of 400,977 patients were identified and grouped by route of hysterectomy. Vaginal hysterectomy demonstrated the lowest inpatient total cost ($6,524.00 [interquartile range $4,831.60, $8,785.70]), and robotic-assisted laparoscopic hysterectomy had the highest total cost ($9,386.80 [interquartile range $6,912.40, $12,506.90]). These differences persisted with fixed and variable costs. High-volume laparoscopic and robotic surgeons (more than 50 cases per year) had a decrease in the cost difference when compared with costs of vaginal hysterectomy. Abdominal hysterectomy had a higher rate of complications relative to vaginal hysterectomy (adjusted odds ratio [aOR] 1.52, 95% CI, 1.39-1.67), whereas laparoscopic (aOR 0.85, 95% CI, 0.80-0.89) and robotic-assisted (aOR 0.92, 95% CI, 0.84-1.00) hysterectomy had lower rates of complications compared with vaginal hysterectomy. CONCLUSION: Robotic-assisted hysterectomy is associated with higher surgical costs compared with other approaches, even when accounting for surgeon volume. Complication rates are low for minimally invasive surgery, and it is unlikely that the robotic-assisted approach provides an appreciable improvement in perioperative outcomes.
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INTRODUCTION: Despite rural origin being a strong predictor of rural practice for health care professionals, rural students face educational barriers and are underrepresented in medical schools. The aim of this study was to identify rural high school students' perceived barriers to college and health-related careers and compare whether perceptions were similar based on gender, socioeconomic status (SES), and parental education. METHODS: We performed a cross-sectional survey of all high school students from one rural Michigan community. The survey included 13 multiple-choice and 5 short-answer questions. We compared results using χ2 analysis and logistic regression. Free-text answers were grouped thematically and analyzed for patterns. RESULTS: Survey response rate was 97.1% (506/521); 45.3% (229/506) of students were contemplating health care careers. Rural females were more likely to plan on college (females 83.9%, males 75.6%, P=0.03) and to contemplate a health care career (females 64.1%, males 25.2%, P<0.01). Students of lower SES and those who would be first-generation college students were less likely to plan on college (SES: low 76.8%, high 84.7%, P=.04; parental college: yes 84.4%, no 72.0%, P<0.01), although they were equally likely as other students to consider a health care career. Gender and parental education were significant independent predictors of plans for college; female gender was the only significant predictor for health care interest. The most frequently reported barrier to post-high school education was financial, and for health care training, it was academic success. CONCLUSIONS: Rural students are interested in health-related careers. Addressing perceived academic and financial barriers for students from high-need rural communities may inform targeted interventions to increase the rural health care workforce.
