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Nationwide Use of Laparoscopic Hysterectomy Compared With Abdominal and Vaginal Approaches

Jacoby, Vanessa L. MD, MAS1; Autry, Amy MD1; Jacobson, Gavin MD2; Domush, Robert MD1; Nakagawa, Sanae MA1; Jacoby, Alison MD1

doi: 10.1097/AOG.0b013e3181b9d222
Original Research

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

A laparoscopic approach to hysterectomy is associated with age and surgical diagnosis, but nonclinical factors such as race and ethnicity, income, and insurance also affect laparoscopy rates.

From the 1University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and the 2Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California.

Dr. Vanessa L. Jacoby is supported by the Women’s Reproductive Health Research Career Development Program (grant K12 HD001262).

Corresponding author: Vanessa L. Jacoby, 1635 Divisadero Street, Suite 600, San Francisco, CA, 94115; e-mail: jacobyv@obgyn.ucsf.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.