Objective
Hysterectomy affects 1 in 9 females during her lifetime and is the most frequently performed nonobstetric procedure in women. Understanding the latest pattern of care related to hysterectomies can inform clinical counseling and identify areas for improvement. This study provides an update of care patterns for inpatient hysterectomy in the United States in 2012.
Study Design
We used the 2012 National Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project to identify all nonobstetric hysterectomies performed in women 18 years of age or older based on International Classification of Diseases , ninth revision, Clinical Modification diagnosis and procedure codes. We analyzed the hysterectomy route and its association with patient and hospital characteristics. The NIS sample weight was applied to generate nationally representative estimates. All analysis was conducted in SAS version 9.3 (SAS Institute Inc, Cary, NC).
Study Design
We used the 2012 National Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project to identify all nonobstetric hysterectomies performed in women 18 years of age or older based on International Classification of Diseases , ninth revision, Clinical Modification diagnosis and procedure codes. We analyzed the hysterectomy route and its association with patient and hospital characteristics. The NIS sample weight was applied to generate nationally representative estimates. All analysis was conducted in SAS version 9.3 (SAS Institute Inc, Cary, NC).
Results
Nationally, 62,364 inpatient hysterectomies, representing 311,820 hysterectomies after applying sample weight, were performed in 2012 for nonobstetric indications in adult women ( Table ). Most (84.9%) were performed for benign indications, with uterine fibroids (50.4%), menstrual disorders (48.8%), and genital prolapse (20.0%) as the leading diagnoses for benign hysterectomies. Half of the benign hysterectomies (51.2%) were performed abdominally, and 31.8% and 16.9% were performed via laparoscopic and vaginal approaches, respectively. Two fifths of benign laparoscopic hysterectomies (39.6%) were robotically assisted, accounting for 12.6% of all benign hysterectomies. Patients who received vaginal hysterectomy were older (mean, 52.3 years) than those undergoing abdominal or laparoscopic routes (mean, 46.5 years for both) ( P < .001). White patients were more likely to receive vaginal or laparoscopic hysterectomy and less likely to undergo abdominal hysterectomy, compared with nonwhite patients ( P < .001). There is also a significant difference in hysterectomy route by hospitals’ urban/rural location ( P < .001) and Census region ( P < .001).
| Route | Overall | Benign | Malignant | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All | Age, mean (SEM) a | Race b | Region | Urban-rural/teaching status | |||||||||
| White, % | Nonwhite, % | Northeast, % | Midwest, % | South, % | West, % | Urban teaching, % | Urban nonteaching, % | Rural, % | |||||
| Total | 311,820 | 264,775 | 264,775 | 153,630 | 94,740 | 45,660 | 58,950 | 98,965 | 61,200 | 128,790 | 102,935 | 33,050 | 47,045 |
| Abdominal | 52.8% | 51.2% | 46.5 (0.1) | 46.9% | 60.4% | 51.1% | 49.1% | 58.9% | 40.7% | 50.7% | 50.7% | 54.7% | 61.7% |
| Vaginal | 14.7% | 16.9% | 52.3 (0.2) | 18.7% | 12.7% | 15.7% | 18.8% | 13.7% | 21.3% | 16.4% | 16.9% | 19.1% | 2.0% |
| Laparoscopic | 32.4% | 31.8% | 46.5 (0.1) | 34.2% | 26.7% | 33.1% | 31.9% | 27.2% | 37.9% | 32.8% | 32.3% | 26.1% | 36.0% |
| Other | 0.2% | 0.1% | 49.4 (1.5) | 0.1% | 0.2% | 0.1% | 0.2% | 0.2% | 0.1% | 0.2% | 0.1% | 0.1% | 0.3% |
| P value c | NA | NA | < .001 | < .001 | < .001 | < .001 | NA | ||||||
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