title: 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 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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  III.
authors.affiliation: From the University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, and the Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Jacoby
authors.forename: Amy
authors.initials: A
authors.lastname: Autry
authors.forename: Gavin
authors.initials: G
authors.lastname: Jacobson
authors.forename: Robert
authors.initials: R
authors.lastname: Domush
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Alison
authors.initials: A
authors.lastname: Jacoby
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data*; D007182:Income; D007348:Insurance, Health; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio