Trends in the Safety of Inpatient Hysterectomy for Benign Conditions in California, 1991–2004

Abstract

The introduction of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign uterine conditions and its increasing use during the 1990s coincided with a dramatic decrease in the incidence of total abdominal hysterectomy (TAH). The aim of this study was to assess the effects of this marked shift in hysterectomy technique on inpatient safety and to analyze the complications associated over time with increasing use of inpatient LAVH. Data was obtained from the California Patient Discharge Database for the years 1991 to 2004 for 649,758 women age 20 years and older undergoing inpatient hysterectomy for nonmalignant and nonobstetric indications. The incidence and complication rates for LAVH, TAH, vaginal hysterectomy (VH), and subtotal hysterectomy (SAH) were compared. Multiple logistic regression models analyzed factors contributing to the risk of medical and surgical complications. During the study period, there was a substantial decrease in the incidence of any type of inpatient hysterectomy for benign conditions (P < .001). TAH decreased 38.8% (P < .001). The rates of LAVH and STH increased 10-fold and 17-fold, respectively. The median length of hospital stay for each type of hysterectomy also decreased. The odds of the medical and surgical complications of each type of hysterectomy decreased during the study period (P < .001). Older age, African-American race, and the presence of comorbidities were associated with increased odds of complications. There was a simultaneous reduction in TAH rates and increase in SAH rates. As surgeons became experienced with LAVH, there was a steep decline in the LAVH-to-laparotomy conversion rates (conversion rates: 61% in 1991; 24% in 1992; 4.5% in 2004). These data show substantial reductions in the both incidence of inpatient hysterectomy for benign gynecological conditions and the odds of complications in California between 1991 and 2004.