Outpatient Hysterectomy Volume in the United States

OBJECTIVE: To estimate the number of outpatient hysterectomies being performed annually in the United States in an effort to offer more correct estimates of hysterectomy use in light of reported decreasing inpatient case volume. METHODS: This is a cross-sectional analysis of State Ambulatory Surgery and Services Databases from 16 states with complete information for year 2011. Adult women undergoing hysterectomy were included. Procedure volume, route, and associated patient and surgical characteristics were calculated. RESULTS: There were 64,612 ambulatory hysterectomies reported; 81.5% of surgeries were performed laparoscopically and 16% vaginally. If these numbers are extrapolated to national estimates, this represents 100,000-200,000 outpatient hysterectomies per year. The strongest driver of the laparoscopic, compared with vaginal, route of hysterectomy in this data set was presence of cancer (odds ratio 4.01 [3.19-5.05], P<.001). In addition to indication for surgery, patient characteristics such as age, race, income, location, and primary payer were associated with mode of hysterectomy. The laparoscopic surgeries were associated with shorter length of stay (mean stay 0.65 days, [99% confidence interval 0.65-0.66] compared with 0.79 days [0.78-0.81], adjusted incidence rate ratio 0.89 [0.86-0.92], P<.001) and higher mean charges ($24,227 [$24,053-24,402] versus $14,068 [$13,811-14,330], P<.001) compared with vaginal surgeries. CONCLUSION: The perceived decline that has been reported in national hysterectomy volume may represent lack of reporting of surgeries performed in ambulatory settings. This information has considerable implications for business, public health interventions, and insurance carriers among other key stakeholders in women's health care delivery.