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

Abstract

Study Objective To identify patient and hospital characteristics associated with minimally invasive (MIS) 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 or Participants Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016-2018. Interventions None. Measurements and Main Results We determined the significance of the proportion of 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 non-federal Illinois hospitals from 2016-2018. Over three quarters (32,387, 75.4%) of hysterectomies were MIS. Non-Hispanic Black patients had the lowest percentage of MIS (54.7%) compared to 82.1% among Whites (p <0.001). Being non-Hispanic Black (OR=0.53, 95% CI 0.47-0.60), Other/unknown race and ethnicity (OR=0.76, 95% CI 0.52-0.85), or having a diagnosis of fibroids (OR=0.54, 95% CI 0.49-0.60) were associated with lower likelihood of MIS. Patients treated at hospitals with >80% MIS, had almost six times the likelihood of MIS (OR=5.89, 95% CI 4.51-7.68). Conclusion Black race and a fibroid diagnosis are independently associated with decreased odds of undergoing MIS hysterectomy, while the strongest predictor of undergoing MIS hysterectomy was hospital proportion of minimally invasive procedures. To identify patient and hospital characteristics associated with minimally invasive (MIS) hysterectomy. Retrospective population-based analysis of administrative data. Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database. Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016-2018. None. We determined the significance of the proportion of 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 non-federal Illinois hospitals from 2016-2018. Over three quarters (32,387, 75.4%) of hysterectomies were MIS. Non-Hispanic Black patients had the lowest percentage of MIS (54.7%) compared to 82.1% among Whites (p <0.001). Being non-Hispanic Black (OR=0.53, 95% CI 0.47-0.60), Other/unknown race and ethnicity (OR=0.76, 95% CI 0.52-0.85), or having a diagnosis of fibroids (OR=0.54, 95% CI 0.49-0.60) were associated with lower likelihood of MIS. Patients treated at hospitals with >80% MIS, had almost six times the likelihood of MIS (OR=5.89, 95% CI 4.51-7.68). Black race and a fibroid diagnosis are independently associated with decreased odds of undergoing MIS hysterectomy, while the strongest predictor of undergoing MIS hysterectomy was hospital proportion of minimally invasive procedures.