National trends and determinants of hospitalization costs and lengths-of-stay for uterine fibroids procedures.

Uterine fibroid admissions in the nation's hospitals have grown more than 20 percent over the past five years. Substantial variations exist in inpatient treatment patterns. In spite of this dramatic growth, there are no national studies of the hospital costs associated with the treatment of uterine fibroids in the hospital setting. Using 11 years of data (1993-2003) from the Healthcare Cost and Utilization Project, a nationally representative 20 percent sample of the nation's inpatient admissions, trends in hospital charges, costs, and lengths of stay (LOSs) are reported. For 2001 to 2003, determinants of hospital costs and LOS for inpatients with a primary diagnosis of uterine fibroids were analyzed using univariate analyses and regression techniques. Hysterectomies for women with a primary diagnosis of uterine fibroids have in-hospital costs of over $1.5 billion. Among the major procedures for treating uterine fibroids, in 2003, total abdominal hysterectomy had the longest LOS, averaging 2.9 days with a mean cost of $6331. In contrast, the treatment with the shortest LOS, 1.72 days, was laparoscopically assisted vaginal hysterectomy but it had the highest mean costs of $7108. In 2003, supracervical hysterectomies and myomectomies had mean costs of $6809 and $6707, respectively. Multivariate results show that patient characteristics and structural aspects of the hospital are strong predictors of lengths of stay and cost per day but there are major differences across some of the surgical procedures. Although the patient characteristics-insulin-dependent, non-insulin dependent diabetes, obesity, morbid obesity, smoker, hypertension, congestive heart failure, chronic obstructive pulmonary disease-all have significant impacts on LOS and cost per day for some of the major uterine fibroid treatments, they are not consistent. Compared with white women, black, Hispanic, and Asian/Pacific Island women all had higher lengths of stay and costs per day. Bedsize and teaching status are generally positively associated with lengths of stay and costs per day; for-profit status always had a significant positive association with LOS and cost per day. Hospital costs for treating women with uterine fibroids are continuing to grow. Further research on the determinants of the resource utilization could be helpful in predicting and alleviating these costs and improving patient care.