Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection.
To examine utilization patterns of different laparoscopic approaches in inpatient hysterectomy and identify patient and hospital characteristics associated with the selection of specific laparoscopic approaches.



Using data from the 2007 to 2012 National (Nationwide) Inpatient Sample (NIS), we identified adult women undergoing inpatient laparoscopic hysterectomy for nonobstetric indications based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Benign cases were categorized based on laparoscopic approach, classified as total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), or laparoscopic supracervical hysterectomy (LSH). We assessed changes in the use of these approaches during 2007 to 2012, and used multinomial logistic regression to examine the association of patient and hospital characteristics with the choice of laparoscopic approach in 2012. The NIS sample weights were applied to generate nationally representative estimates.



Retrospective study (Canadian Task Force classification III).



Hospital inpatient care nationwide.



Female adult patients in the NIS database who underwent an inpatient laparoscopic hysterectomy between 2007 and 2012.



Inpatient laparoscopic hysterectomy.



Of the inpatient laparoscopic hysterectomies performed in 2012, 83.2% were for benign indications. The TLH approach accounted for 48.3% of all laparoscopic hysterectomies, followed by LAVH at 37.3% and LSH at 14.4%. Robotic assistance was reported in 45.0% of all cases and 72.3% of malignant hysterectomies. An examination of temporal trends during 2007 to 2012 demonstrates a shift in the laparoscopic approach from LAVH toward TLH, with a slight decrease in LSH. Patient race/ethnicity, income, indication for hysterectomy, and comorbid conditions, as well as hospital teaching status, urban/rural location, bed size, type of ownership, and geographic region, were significantly associated with the choice of laparoscopic approach.



Benign laparoscopic hysterectomy is increasingly performed as TLH rather than LAVH. In addition to clinical factors, the selection of laparoscopic approach is influenced by patient socioeconomic and hospital characteristics.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT. Electronic address: vrunda.desai@yale.edu.
Vrunda Bhavsar
VB
Desai
Yale University School of Medicine, New Haven, CT.
Xiaoyue M
XM
Guo
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Linda
L
Fan
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY.
Jason D
JD
Wright
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Xiao
X
Xu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D007297:Inpatients; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Laparoscopic hysterectomy; Trends