Use of Alternative Techniques of Hysterectomy in Ohio, 1988–1994

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Abstract
Laparoscopically assisted vaginal hysterectomy has been promoted as a substitute for both abdominal and vaginal hysterectomy, with claimed benefits of lower costs, shorter hospital stays, and quicker postoperative recovery. Using computerized hospital-discharge data for 1988-1994 from 180 hospitals in Ohio, we analyzed rates of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy and their association with characteristics of patients, complications, in-hospital mortality, and hospital charges. The annual age-adjusted rate of hysterectomy fell 10 percent, from 4.53 per 1000 female state residents in 1988 to 4.07 per 1000 in 1994 (P<0.001). In 1988, 1.1. percent of all hysterectomies were performed by the laparoscopically assisted vaginal technique; this proportion increased to 9.2 percent in 1993 and declined to 7.5 percent in 1994. For gynecologic conditions other than cancer or pregnancy, women undergoing laparoscopically assisted vaginal hysterectomy as compared with one of the other techniques were more likely to have commercial insurance and to have their surgery at an urban hospital for diagnoses related to pain, endometriosis, or pelvic inflammatory disease. With abdominal and laparoscopically assisted vaginal hysterectomy, the complication rates were similar and were higher than those with vaginal hysterectomy. In-hospital mortality was similar for vaginal and laparoscopically assisted vaginal hysterectomy and was lower than for abdominal hysterectomy. Median hospital charges were $8,108 for laparoscopically assisted vaginal hysterectomy, $5,723 for abdominal hysterectomy, and $5,049 for vaginal hysterectomy. The rate of hysterectomy in Ohio decreased from 1988 to 1994, as laparoscopically assisted vaginal hysterectomy became more common. Laparoscopically assisted vaginal hysterectomy was associated with higher hospital charges than the other techniques.