Nationwide Use of Laparoscopic Hysterectomy Compared With Abdominal and Vaginal Approaches

OBJECTIVE: To examine factors associated with undergoing laparoscopic hysterectomy compared with abdominal hysterectomy or vaginal hysterectomy. METHODS: This is a cross-sectional analysis of the 2005 Nationwide Inpatient Sample. All women aged 18 years or older who underwent hysterectomy for a benign condition were included. Multivariable analyses were used to examine demographic, clinical, and health-system factors associated with each hysterectomy route. RESULTS: Among 518, 828 hysterectomies, 14% were laparoscopic, 64% abdominal, and 22% vaginal. Women older than 35 years had lower rates of laparoscopic than abdominal (odds ratio OR 0. 85, 95% confidence interval CI 0. 77-0. 94 for age 45-49 years) or vaginal hysterectomy (OR 0. 61, 95% CI 0. 540. 69 for age 45-49 years). The odds of laparoscopic compared with abdominal hysterectomy were higher in the West than in the Northeast (OR 1. 77, 95% CI 1. 2-2. 62). African-American, Latina, and Asian women had 40-50% lower odds of laparoscopic compared with abdominal hysterectomy (P<. 001). Women with low income, Medicare, Medicaid, or no health insurance were less likely to undergo laparoscopic than either vaginal or abdominal hysterectomy (P<. 001). Women with leiomyomas (P<. 001) and pelvic infections (P<. 001) were less likely to undergo laparoscopic than abdominal hysterectomy. Women with leiomyomas (P<. 001), endometriosis (P<. 001), or pelvic infections (P<. 001) were more likely to have laparoscopic than vaginal hysterectomy. Laparoscopic hysterectomy had the highest mean hospital charges (18, 821, P<. 001) and shortest length of stay (1. 65 days, P<. 001). CONCLUSION: In addition to age and clinical diagnosis, nonclinical factors such as race/ethnicity, insurance status, income, and region appear to affect use of laparoscopic hysterectomy compared with abdominal hysterectomy and vaginal hysterectomy. LEVEL OF EVIDENCE: III.