Updated Hysterectomy Surveillance and Factors Associated With Minimally Invasive Hysterectomy

BACKGROUND AND OBJECTIVES The goal of this study is to obtain updated surveillance statistics for hysterectomy procedures in the United States and identify factors associated with undergoing a minimally invasive approach to hysterectomy. METHODS A cross-sectional analysis of the 2009 United States Nationwide Inpatient Sample was performed. Subjects included all women aged 18 years or older who underwent hysterectomy of any type. Logistic regression and multivariate analyses were performed to assess the proportion of hysterectomies performed by various routes, as well as factors associated with undergoing minimally invasive surgery (laparoscopic, vaginal, or robotic). RESULTS A total of 479,814 hysterectomies were performed in the United States in 2009, 86.6% of which were performed for benign indications. Among the hysterectomies performed for benign indications, 56% were completed abdominally, 20.4% were performed laparoscopically, 18.8% were performed vaginally, and 4.5% were performed with robotic assistance. Factors associated with decreased odds of a minimally invasive hysterectomy included the following: minority race (P<.0001), fibroids (P<.0001), concomitant adnexal surgery (P<.0001), self-pay (P=.01) or Medicaid as insurer (P<.0001), and increased severity of illness (P<.0001). Factors associated with increased odds of a minimally invasive hysterectomy included the following: age>50 years (P<.0001), prolapse or menstrual disorder (P<.0001), median household income of $48,000-$62,999 (P=.007) or ≥$63,000 (P=.009), and location in the West (P=.02). A length of stay>1 day was most common in abdominal hysterectomy cases (96.1%), although total mean charges were highest for robotic cases ($38,161). CONCLUSION The US hysterectomy incidence in 2009 decreased from prior years' reports, with an increasing frequency of laparoscopic and robotic approaches. Racial and socioeconomic factors influenced hysterectomy mode.