Nationwide Use of Laparoscopic Hysterectomy Compared With Abdominal and Vaginal Approaches

Abstract

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 above age 35 years had lower rates of laparoscopic than abdominal (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.770.94 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 infection (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 to abdominal hysterectomy and vaginal hysterectomy.

Estimation of uterine volume: A comparison between Viewpoint and 3D ultrasound estimation in women undergoing laparoscopic hysterectomy

“…Of the various surgical approaches used to remove the uterus, the majority are still approached abdominally (64%); while vaginal (22%) and laparoscopic (14%) hysterectomies continue to gain popularity 2 . However, the prevalence of hysterectomy appears to be decreasing, possibly due to the advent of less invasive therapies for management of conditions previously treated with hysterectomy 3 …”

Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease

“…Traditionally, hysterectomy has been performed abdominally through a laparotomy incision, vaginally, or laparoscopically. Over the past 25 years, technological advances, coupled with changes in practice patterns regarding route of hysterectomy, have led to an increase in minimally invasive options (1,3,4).…”

“…With over 500,000 cases performed each year, it accounts for more than $5 billion in healthcare spending (1,2). Traditionally, hysterectomy has been performed abdominally through a laparotomy incision, vaginally, or laparoscopically.…”

Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy

“…[1][2][3] It has been reported that over two thirds of hysterectomies continue to be performed in the United States as open abdominal procedures, with the lowest rates in the Southern region. [1][2][3][4] It has been well established that minimally invasive techniques, both laparoscopic and vaginal hysterectomy, have distinct advantages over abdominal approaches, including decreased length of hospitalization, reduced postoperative infections, shorter recovery times, and decreased blood loss. [1][2][3][4][5][6][7][8][9][10][11] Historically, TVH has been the route of choice among gynecologists; training for this surgical procedure has been well integrated into Obstetrics and Gynecology residency programs over the past 30 years.…”

“…[1][2][3][4] It has been well established that minimally invasive techniques, both laparoscopic and vaginal hysterectomy, have distinct advantages over abdominal approaches, including decreased length of hospitalization, reduced postoperative infections, shorter recovery times, and decreased blood loss. [1][2][3][4][5][6][7][8][9][10][11] Historically, TVH has been the route of choice among gynecologists; training for this surgical procedure has been well integrated into Obstetrics and Gynecology residency programs over the past 30 years. 5,8 The introduction of laparoscopic techniques, including Laparoscopic Assisted Vaginal Hysterectomy (LAVH), Total Laparoscopic Hysterectomy (TLH), Laparoscopic Supracervical Hysterectomy (LSH), and robotic-assisted hysterectomy (TLH/LSH), had promise to continue decreasing the numbers of AH performed in the United States; these approaches have become integrated into residency training since the early to mid-2000's.…”