May 2018
Predictors of laparoscopic hysterectomy for leiomyoma surgical removal in the United States

Kate Busko, Mark Stuntz
Value in Health / ISPOR
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a b s t r a c t

OBJECTIVES : Leiomyomas (uterine fibroids) are benign tumors that are prevalent among women of reproductive age and affect approximately 80% of premenopausal women. Hysterectomy is one of the most common surgical procedures for removal of uterine fibroids. Laparoscopic hysterectomy (LH) has increasingly been used as an alternative to the open surgical hysterectomy (OSH). The purpose of this study was to identify predictors of LH procedures among leiomyoma patients.

METHODS : The National Inpatient Sample (NIS) is the largest publicly available inpatient healthcare database in the US, containing a 20% stratified systematic random sample of all US community hospital discharges. Thirteen years of available data, 2002–2014, were used for this analysis. International Classification of Diseases 9th revision (ICD-9) codes were used to identify all records of women with primary discharge diagnosis of uterine leiomyoma who had undergone either LH or OSH. Multivariate logistic regression analysis was conducted to identify significant predictors of LH. Population sampling weights were used to extrapolate results to national estimates.

RESULTS : There were 310,150 leiomyoma LH procedures from 2002 to 2014, corresponding to 22.5% of the total number of leiomyoma hysterectomy procedures. The mean age of patients undergoing LH was significantly higher than those undergoing OSH (45.69 years vs 43.29 years; p<0.001). After adjusting for covariates, significant predictors of LH procedures included age > 50 years (OR=3.18; 95% CI=3.57-4.07), hospital location in the West (OR=1.46; 95% CI=1.38-1.86), and hospital urban non-teaching status (OR=1.20; 95% CI=1.04-1.38).

CONCLUSIONS : The study shows that despite the advances in surgical technologies, there are very few predictors of non-conventional laparoscopic approach to leiomyoma hysterectomy. Our findings suggest that there is a differential access to LH procedures among the US population which may be, in part, a result of racial and socioeconomic differences and centralization of laparoscopy services in urban areas.