Operative management of ectopic pregnancy: A cost analysis, ,

OBJECTIVES: The purpose of this study was to analyze the cost for hospital-based services related to the operative management of ectopic pregnancies and determine the most cost-conscious approach by distinguishing the constituent components. STUDY DESIGN: This is a retrospective comparative review of every ectopic pregnancy that was surgically managed at the Memorial Medical Center of Long Beach. Unit cost estimates that are based on a cost accounting system were derived and compared between different procedures according to resources used among separate services. RESULTS: Hemodynamic instability significantly increases the cost of management by increasing the length of stay and laboratory costs. Among stable patients laparoscopic excision of ectopic pregnancies saves nearly 25% per case (p< 0.001) compared with laparotomy. However, when we compared all intended laparoscopic excisions (i.e., including the 21% of cases in which laparotomy was eventually done), the savings were markedly reduced. In addition, the cost savings was lost if patients undergoing laparotomy were discharged on or before postoperative day 2. Discharging patients after laparotomy on postoperative day 1 is the least costly management for operative treatment of ectopic pregnancy. CONCLUSIONS: Whereas laparoscopy may decrease recuperation time and incisional scarring, operative cost is not a significant reason to choose laparoscopy over laparotomy in a hemodynamically stable patient, especially as postoperative stays decrease. (Am J Obstet Gynecol 1996;175:90-6.)