Age-related patterns in hysterectomy: indications and surgical route selection in a three-year tertiary-center cohort

BACKGROUND: Hysterectomy indications and surgical route selection may vary with age due to shifting case mix. OBJECTIVES: To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection. DESIGN: Retrospective chart review. SETTINGS: Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology. METHODS: Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age <50, 50-59, or ≥60 years. Indications were assigned using PALM-COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal-Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery. MAIN OUTCOME MEASURES: age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery. SAMPLE SIZE: 769 hysterectomies. RESULTS: <.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those ≥60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age ≥60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08-3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02-46.60). In binary regression, age ≥60 years (aOR 4.18, 95% CI 2.41-7.26) and parity (aOR 1.18 per birth, 95% CI 1.06-1.32) favored minimally invasive surgery. CONCLUSIONS: Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients. LIMITATIONS: Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.