Table 4.
Logistic Regression Analysis Comparing Minimally Invasive Hysterectomy (Laparoscopic, Vaginal, or Robotic) With Abdominal Hysterectomy Among Women With Benign Conditions
| Abdominal (n = 232 633) |
Minimally Invasive (n = 181 346) |
Crude ORa (95% CIa) | Adjustedb OR (95% CI) | P Value | |||
|---|---|---|---|---|---|---|---|
| n | (%) | n | (%) | ||||
| Age | |||||||
| 18–34 y | 22 947 | (9.9) | 19 596 | (10.8) | 1.00 (reference) | 1.00 (reference) | |
| 35–39 y | 32 685 | (14.0) | 25 461 | (14.0) | 0.91 (0.85–0.98) | 0.99 (0.92–1.06) | .69 |
| 40–44 y | 55 285 | (23.8) | 36 000 | (19.9) | 0.76 (0.71–0.82) | 0.94 (0.87–1.01) | .09 |
| 45–49 y | 60 805 | (26.1) | 38 314 | (21.1) | 0.74 (0.68–0.80) | 1.03 (0.95–1.11) | .47 |
| 50–54 y | 30 480 | (13.1) | 21 374 | (11.8) | 0.82 (0.75–0.90) | 1.21 (1.10–1.32) | <.0001 |
| ≥55 y | 30 432 | (13.1) | 40 601 | (22.4) | 1.56 (1.40–1.75) | 1.34 (1.21–1.49) | <.0001 |
| Race/ethnicity | |||||||
| White | 121 790 | (52.4) | 115 264 | (63.6) | 1.00 (reference) | 1.00 (reference) | |
| Black | 43 829 | (18.8) | 13 823 | (7.6) | 0.33 (0.30–0.37) | 0.51 (0.45–0.57) | <.0001 |
| Hispanic | 23 478 | (10.1) | 15 937 | (8.8) | 0.72 (0.63–0.81) | 0.67 (0.59–0.78) | <.0001 |
| Asian/Pacific Islander | 5649 | (2.4) | 3117 | (1.7) | 0.58 (0.47–0.72) | 0.58 (0.46–0.74) | <.0001 |
| Native American | 1320 | (0.6) | 1807 | (1.0) | 1.45 (0.91–2.29) | 1.68 (1.04–2.71) | .03 |
| Other | 6779 | (2.9) | 4059 | (2.2) | 0.63 (0.53–0.76) | 0.70 (0.58–0.84) | .0002 |
| Missing | 29 788 | (12.8) | 27 339 | (15.1) | 0.97 (0.79–1.19) | 1.09 (0.89–1.33) | .43 |
| Indicationb | |||||||
| Fibroids | 142 501 | (61.3) | 71 976 | (39.7) | 0.42 (0.39–0.44) | 0.51 (0.48–0.54) | <.0001 |
| Endometriosis | 59 311 | (25.5) | 37 650 | (20.8) | 0.77 (0.71–0.83) | 0.93 (0.86–1.01) | .08 |
| Prolapse | 12 812 | (5.5) | 64 687 | (35.7) | 9.51 (8.18–11.1) | 6.53 (5.60–7.62) | <.0001 |
| Menstrual disorder | 120 861 | (52.0) | 91 579 | (50.5) | 0.94 (0.89–1.01) | 1.33 (1.24–1.43) | <.0001 |
| Other | 29 101 | (12.5) | 12 353 | (6.8) | 0.51 (0.47–0.56) | 0.71 (0.64–0.79) | <.0001 |
| Adnexal surgery | 147 086 | (63.2) | 72 200 | (39.8) | 0.38 (0.36–0.41) | 0.39 (0.36–0.41) | <.0001 |
| Urban–rural location | |||||||
| “Central” ≥1 million | 62 194 | (27.0) | 44 117 | (24.7) | 1.00 (reference) | 1.00 (reference) | |
| “Fringe” ≥1 million | 59 549 | (25.9) | 44 765 | (25.1) | 1.06 (0.91–1.24) | 0.93 (0.78–1.12) | .45 |
| Metropolitan areas of 250 000–999 999 population | 39 174 | (17.0) | 33 708 | (18.9) | 1.21 (0.98–1.50) | 1.03 (0.81–1.32) | .80 |
| Metropolitan areas of 50 000–249 999 population | 21 567 | (9.4) | 21 358 | (12.0) | 1.40 (1.07–1.82) | 1.30 (0.98–1.72) | .07 |
| Micropolitan counties | 29 894 | (13.0) | 21 836 | (12.2) | 1.03 (0.84–1.26) | 0.92 (0.73–1.16) | .50 |
| Not metropolitan or micropolitan counties | 17 655 | (7.7) | 12 842 | (7.2) | 1.03 (0.85–1.24) | 0.93 (0.74–1.15) | .49 |
| Median household income national quartile for patient ZIP code | |||||||
| $1-$38 999 | 63 225 | (27.8) | 38 749 | (21.8) | 1.00 (reference) | 1.00 (reference) | |
| $39 000-$47 999 | 60 414 | (26.6) | 45 718 | (25.8) | 1.23 (1.11–1.37) | 1.02 (0.92–1.13) | .65 |
| $48 000-$62 999 | 53 317 | (23.5) | 47 732 | (26.9) | 1.46 (1.28–1.66) | 1.18 (1.04–1.32) | .007 |
| ≥$63 000 | 50 313 | (22.1) | 45 311 | (25.5) | 1.47 (1.26–1.71) | 1.21 (1.05–1.39) | .009 |
| Primary payer | |||||||
| Medicare | 18 386 | (7.9) | 22 372 | (12.4) | 1.54 (1.41–1.67) | 1.05 (0.96–1.14) | .30 |
| Medicaid | 28 066 | (12.1) | 16 368 | (9.0) | 0.74 (0.67–0.82) | 0.78 (0.71–0.85) | <.0001 |
| Private including HMOa | 165 233 | (71.2) | 130 817 | (72.3) | 1.00 (reference) | 1.00 (reference) | |
| Self-pay | 10 127 | (4.4) | 4181 | (2.3) | 0.52 (0.40–0.69) | 0.69 (0.51–0.93) | .01 |
| No charge | 1020 | (0.4) | 616 | (0.3) | 0.76 (0.54–1.07) | 1.16 (0.73–1.85) | .52 |
| Other | 9203 | (4.0) | 6557 | (3.6) | 0.90 (0.76–1.07) | 0.94 (0.78–1.14) | .53 |
| Region of hospital | |||||||
| Northeast | 35 217 | (15.1) | 27 935 | (15.4) | 1.00 (reference) | 1.00 (reference) | |
| Midwest | 50 965 | (21.9) | 43 587 | (24.0) | 1.08 (0.81–1.43) | 1.06 (0.76–1.48) | .74 |
| South | 106 308 | (45.7) | 65 647 | (36.2) | 0.78 (0.60–1.02) | 0.94 (0.68–1.29) | .70 |
| West | 40 144 | (17.3) | 44 177 | (24.4) | 1.39 (1.04–1.85) | 1.51 (1.08–2.12) | .02 |
| % of all operations performed on outpatient basis | |||||||
| <55 | 71 724 | (31.7) | 59 987 | (34.5) | 1.00 (reference) | 1.00 (reference) | |
| 55–65.9 | 74 897 | (33.1) | 51 603 | (29.7) | 0.82 (0.67–1.02) | 0.79 (0.63–0.98) | .04 |
| ≥66 | 79 887 | (35.3) | 62 125 | (35.8) | 0.93 (0.77–1.12) | 0.85 (0.68–1.06) | .15 |
| Location and teaching status | |||||||
| Rural | 30 754 | (13.5) | 22 535 | (12.7) | 1.00 (reference) | 1.00 (reference) | |
| Urban non-teaching | 103 389 | (45.5) | 81 059 | (45.6) | 1.07 (0.85–1.35) | 0.97 (0.73–1.29) | .82 |
| Urban teaching | 93 221 | (41.0) | 74 167 | (41.7) | 1.09 (0.86–1.37) | 1.13 (0.84–1.53) | .42 |
| Hospital bed size | |||||||
| Small | 23 607 | (10.4) | 21 246 | (12.0) | 1.00 (reference) | 1.00 (reference) | |
| Medium | 60 556 | (26.6) | 45 818 | (25.8) | 0.84 (0.66–1.08) | 0.77 (0.59–1.00) | .05 |
| Large | 143 202 | (63.0) | 110 698 | (62.3) | 0.86 (0.70–1.05) | 0.82 (0.64–1.06) | .13 |
| Severity of illness subclass | |||||||
| Minor loss of function | 159 007 | (68.4) | 136 795 | (75.4) | 1.00 (reference) | 1.00 (reference) | |
| Moderate loss of function | 63 633 | (27.4) | 41 540 | (22.9) | 0.76 (0.72–0.80) | 0.73 (0.69–0.77) | <.0001 |
| Major loss of function | 8253 | (3.5) | 2677 | (1.5) | 0.38 (0.33–0.43) | 0.43 (0.37–0.49) | <.0001 |
| Extreme loss of function | 1741 | (0.7) | 334 | (0.2) | 0.22 (0.17–0.30) | 0.26 (0.19–0.35) | <.0001 |
| AHRQa comorbidity measure for obesity | 28 179 | (12.1) | 14 787 | (8.2) | 0.64 (0.59–0.70) | 0.93 (0.85–1.01) | .10 |
a
AHRQ = Agency for Healthcare Research and Quality; CI, confidence interval; HMO = Health Maintenance Organization; OR, odds ratio.
b
All variables in the table were added to one logistic regression model.