Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

Objective: Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources: Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies: Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods: The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings: Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored >= 10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1$60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus$3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions: The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival

Theoretical study on the mechanisms and kinetics of the β-elimination of 2,2-dihaloethyltrihalosilanes (X = F, Cl, Br) compounds: a DFT study along with a natural bond orbital analysis

The β-elimination kinetics of 2,2-dihaloethyltrihalosilanes in the gas phase has been studied computationally using density functional theory (DFT) along with the M06-2x exchange–correlation functional and the aug-cc-pVTZ basis set. The calculated energy profiles have been supplemented with calculations of rate constants under atmospheric pressure and in the fall-off regime, by means of transition state theory (TST), variational transition state theory (VTST), and statistical Rice–Ramsperger–Kassel–Marcus (RRKM) theory. Activation energies and rate constants obtained using the M06-2x/aug-cc-pVTZ approaches are in good agreement with the available experimental data. Analysis of bond order, natural bond orbitals, and synchronicity parameters suggests that the β-elimination of the studied compounds can be described as concerted and slightly asynchronous. The transition states of these reactions correspond to four-membered cyclic structures. Based on the optimized ground state geometries, a natural bond orbital (NBO) analysis of donor–acceptor interactions also show that the resonance energies related to the electronic delocalization from σC1−C2 bonding orbitals to σ∗C2−Si3 antibonding orbitals, increase from 2,2-difluoroethyltrifluorosilane to 2,2-dichloroethyltrichlorosilane and then to 2,2-dibromoethyltriboromosilane. The decrease of σC1−C2 bonding orbitals occupancies and increase of the σ∗C2−Si3 antibonding orbitals occupancies through σC1−C2→σ∗C2−Si3 delocalizations could facilitate the β-elimination of the 2,2-difluoroethyltrifluorosilane compound, compared to 2,2-dichloroethyltrichlorosilane and 2,2-dibromoethyltriboromosilane.energy barriers; β-elimination processes; rate constants; NBO; reaction mechanism