title: Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis.
abstract: BACKGROUND
  Minimally invasive hysterectomies performed vaginally or laparoscopically are associated with decreased perioperative morbidity. We examined temporal trends and patient and hospital factors associated with the routes of hysterectomy used in the Vancouver Coastal Health and Providence Health Care regions in British Columbia.
  
  
  METHODS
  We performed a retrospective cohort study of all women who had an elective hysterectomy for a benign indication between 2007 and 2011 in 8 hospitals in the region. Logistic regression modeling with mixed effects was used to estimate adjusted odds ratios and 95% confidence intervals for patient and hospital characteristics associated with the route of hysterectomy.
  
  
  RESULTS
  The study involved 4372 women who underwent abdominal (52.3%), vaginal (25.5%) or laparoscopic (22.3%) hysterectomy. From 2007 to 2011, the number of abdominal hysterectomies performed decreased from 58.4% to 47.7%, the number of vaginal hysterectomies performed decreased from 27.5% to 21.1% and the number of laparoscopic hysterectomies performed increased from 14.2% to 31.2% (p < 0.001 for all trends). Patient factors associated with laparoscopic versus abdominal hysterectomy included young age, pain or prolapse indication, absence of fibroid indication, absence of concurrent gynecologic procedure, rural residence and lower socioeconomic status. Patient factors associated with vaginal hysterectomy included older age, prolapse indication and concurrent procedure for prolapse. Hospital location and size were not significantly associated with vaginal hysterectomy, but urban hospital location was associated with laparoscopic hysterectomy.
  
  
  CONCLUSIONS
  The proportion of minimally invasive hysterectomies is increasing and represents approximately half of all hysterectomies performed in the Vancouver Coastal Health and Providence Health Care regions. Vaginal hysterectomies are associated with patient characteristics, whereas laparoscopic hysterectomies are associated with patient and hospital characteristics.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ont. ; School of Population and Public Health, University of British Columbia, Vancouver, B.C.
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C.
authors.forename: Sarka
authors.initials: S
authors.lastname: Lisonkova
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C.
authors.forename: Catherine
authors.initials: C
authors.lastname: Allaire
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C.
authors.forename: Christina
authors.initials: C
authors.lastname: Williams
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C.
authors.forename: Paul
authors.initials: P
authors.lastname: Yong
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, B.C. ; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, B.C.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph