Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018

Abstract

Study objective: To identify patient and hospital characteristics associated with minimally invasive hysterectomy.

Design: Retrospective population-based analysis of administrative data.

Setting: Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database.

Patients: Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016 to 2018.

Interventions: None.

Measurements and main results: We determined the significance of the proportion of minimally invasive surgery (MIS) versus abdominal hysterectomies by patient and hospital characteristics. Multivariable logistic regression was used to determine the association between patient and hospital characteristics and the likelihood of MIS versus abdominal hysterectomy controlling for the simultaneous effects of all patient and hospital characteristics and year of surgery. There were 42 945 hysterectomies for benign indications at 143 nonfederal Illinois hospitals from 2016 to 2018. More than three-fourths (32 387, 75.4%) of hysterectomies were MIS. Non-Hispanic black patients had the lowest percentage of MIS (54.7%) compared with 82.1% among whites (p <.001). Being non-Hispanic black (odds ratio [OR] = 0.53, 95% confidence interval [CI], 0.47-0.60), other or unknown race and ethnicity (OR 0.76, 95% CI, 0.52-0.85), or having a diagnosis of myomas (OR 0.54, 95% CI, 0.49-0.60) were associated with a lower likelihood of MIS. Patients treated at hospitals with >80% MIS had almost 6 times the likelihood of MIS (OR 5.89, 95% CI, 4.51-7.68).

Conclusion: Black race and a myoma diagnosis were independently associated with decreased odds of undergoing an MIS hysterectomy, whereas the strongest predictor of undergoing an MIS hysterectomy was hospital proportion of minimally invasive procedures.

Keywords: Gynecologic surgery; Health disparity; Health inequity; Hysterectomy; Minimally invasive surgery.