Participation of the general gynecologist in surgical staging of endometrial cancer: Analysis of cost and perioperative outcomes

Objective.To compare the cost and perioperative outcomes of endometrial cancer staging when the procedure is performed by a gynecologic oncologist alone or when a general gynecologist participates in the procedure.Methods.A retrospective analysis was performed on a series of women with clinical stage I endometrial cancer treated at a single institution between 1/98 and 12/00. The patients were grouped according to the participation of a general gynecologist in their surgery. The 48 patients in Group 1 underwent surgery with a general gynecologist who consulted a gynecologic oncologist intraoperatively. Group 2 included 77 patients whose procedure was performed completely by a gynecologic oncologist. The two groups were compared with the chi-square, Fisher's exact, and Wilcoxon rank sum tests. Cost analysis included total hospital costs (room, pharmacy, and ancillary services) and total surgical costs (anesthesia, operating room, procedure, and perioperative physician evaluation costs).Results.The groups did not differ in age, type of surgeries performed, distribution of surgical stage, proportion of patients undergoing lymph node sampling (LNS), and length of follow-up. When LNS was performed, Group 2 had a significantly shorter median operative time (170 vs. 180 min; P = 0.05) and shorter total time in the operating room (204 vs. 224 min; P = 0.02). This group had a lower procedure cost when considered both in terms of payor's cost ($1,414 vs. $2,134; P < 0.0001) and physician charge ($7,106 vs. $11,116; P < 0.0001). Perioperative physician evaluation was reduced by almost half ($685 vs. $424; P < 0.0001) in Group 2. Group 2 had a savings in total surgical cost by payor's cost ($9,142 vs. 10,294; P = 0.005) or physician's charge ($14,546 vs. $19,276; P < 0.0001), and in combined hospital and surgical cost by payor's cost ($15,664 vs. $17,346; P = 0.004) or physician charge ($21,311 vs. $26,328; P < 0.0001). Total hospital costs, however, did not differ between groups.Conclusion.Operative time and costs increase when general gynecologists participate in the surgical procedure of patients with clinical stage I endometrial cancer. Although perioperative outcomes are similar, the involvement of two surgeons increases the length of the procedure as well as the cost of operating room time and physician reimbursement. The efficient use of limited health care resources must be considered as we plan the surgical approach to endometrial cancer.