title: Disparities in use of laparoscopic hysterectomies: a nationwide analysis.
abstract: OBJECTIVE
  To determine patient and hospital characteristics that were associated with undergoing laparoscopic hysterectomy compared with abdominal hysterectomy.
  
  
  METHODS
  Canadian Task Force Classification II-3.
  
  
  METHODS
  In this retrospective cohort study, we analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. All women who underwent laparoscopic or abdominal hysterectomy for either menorrhagia or leiomyoma were included based on International Classification of Diseases, Ninth Revision coding. A linear model with binomial distribution and logit link function was used to determine patient and hospital characteristics associated with hysterectomy approach.
  
  
  RESULTS
  A total of 32 436 patients were included in this study. Of these, 32% patients underwent laparoscopic hysterectomies, and 67% underwent abdominal hysterectomies. With regard to patient characteristics, women younger than 35 years old were more likely to undergo laparoscopic hysterectomy when compared with each of the other age categories (p < .001). White women were more likely to undergo laparoscopic hysterectomy than black women, Hispanic women, or women classified as "other" races (p < .001 for all comparisons). With regard to median income, patients from the lowest national quartile were less likely to undergo laparoscopic hysterectomy when compared with each of the other 3 national quartiles for income (p = .01, p < .001, p = .001, respectively). Payment by private insurance was associated with laparoscopic hysterectomy when compared with payment by Medicare or payment by insurance category "other" (p < .001 for both). With regard to hospital characteristics, hospitals in the Northeast were more likely to have laparoscopic hysterectomies than hospitals in the Midwest or South (p < .001 for both comparisons); urban hospitals were more likely than rural hospitals (p < .001); teaching hospitals were more likely than nonteaching hospitals (p < .001); and government-owned hospitals were less likely than private, nonprofit or private, investor owned (p < .001 for both comparisons).
  
  
  CONCLUSIONS
  Despite the increased popularity of and training in laparoscopic hysterectomies, there remains an obvious disparity in its delivery with regard to patient and hospital characteristics. Further investigation is needed on the etiology of this disparity and interventions that may alleviate it.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas. Electronic address: popatel@utmb.edu.
authors.forename: Pooja R
authors.initials: PR
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Jinhyung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Rodriguez
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Borahay
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Snyder
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Hankins
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
authors.forename: Gokhan S
authors.initials: GS
authors.lastname: Kilic
mesh_terms: D001741:Black or African American; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006779:Hospitals, Public; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D044465:White People; D016387:Women's Health
keywords: Disparities; Laparoscopic hysterectomy; Nationwide Inpatient Sample