Trends in the national distribution of laparoscopic hysterectomies from 2003 to 2010.
OBJECTIVE
The purpose of this analysis was to compare the trends in undergoing laparoscopic hysterectomy (versus abdominal or vaginal hysterectomy) based on patient age, race, median income and insurance type, from 2003 to 2010.


METHODS
Retrospective study (Canadian Task Force classification II-3).


METHODS
National sample of hospital admissions after hysterectomy.


METHODS
Health Cost and Utilization Project-Nationwide Inpatient Sample database was used to review records of women who underwent hysterectomy for either menorrhagia or leiomyoma from 2003-2010.


METHODS
The predicted probability of undergoing laparoscopic hysterectomy was determined for each year according to patient age, race, median income, and insurance type. The slopes of these values (i.e. the trend) was compared for each subgroup (i.e. black, white, Asian, etc.) in these categories.


RESULTS
A total of 530, 154 cases were included in this study. Total number of hysterectomies decreased by 39% from 60,364 to 36,835 from 2003 to 2010. The percent of hysterectomies that were laparoscopic increased from 11% in 2003 to 29% in 2010. All groups analyzed experienced an increase in predicted probability of undergoing a laparoscopic hysterectomy. Of all women undergoing hysterectomy, the probability of undergoing a laparoscopic hysterectomy remained highest for women who were less than 35 years old, white, with the highest median income, and with private insurance from 2003-2010. The slope was significantly greater for (1) white females versus all other races analyzed (p<0.01), (2) females in the highest income quartile versus females in the lowest income quartile (p<0.01) and (3) females with private insurance versus females with Medicaid (p<0.01) or Medicare (p<0.01).


CONCLUSIONS
There remains a gap in distribution of laparoscopic hysterectomies with regards to age, race, median income and insurance type that does not seem to be closing, despite the increased availability of laparoscopic hysterectomies.
Department of Internal Medicine, The University of Texas Medical Branch in Galveston, Texas.
Jinhyung
J
Lee
Department of Biostatistics, The University of Texas Medical Branch in Galveston, Texas.
Kristofer
K
Jennings
Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, Texas.
Mostafa A
MA
Borahay
Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, Texas.
Ana M
AM
Rodriguez
Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, Texas.
Gokhan S
GS
Kilic
Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, Texas.
Russell R
RR
Snyder
Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, Texas. Electronic address: popatel@utmb.edu.
Pooja R
PR
Patel
D000328:Adult; D017677:Age Distribution; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000639:trends*; D007045:Hysterectomy, Vaginal; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health; D010535:Laparoscopy / Q000639:trends*; D007889:Leiomyoma / Q000601:surgery*; D016015:Logistic Models; D008484:Medicaid; D006278:Medicare; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D014481:United States; D014594:Uterine Neoplasms / Q000601:surgery*
Disparity; Laparoscopic hysterectomies