Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy.

Background and objectivesThe 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.MethodsA 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).ResultsA 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 (P50 years (P<.0001), prolapse or menstrual disorder (P1 day was most common in abdominal hysterectomy cases (96.1%), although total mean charges were highest for robotic cases ($38,161).ConclusionThe 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.