Current and Future Trends in Performance of Vaginal Hysterectomy in the United States

Abstract

OBJECTIVE: To describe the current and future use of vaginal hysterectomy in the United States for benign indications. METHODS: In this retrospective cohort study using data from the PINC AI Healthcare Database, we analyzed patients who underwent hysterectomy for benign indications from 2006 to 2020. Hysterectomy was classified as abdominal, vaginal, or minimally invasive (laparoscopic or robotic-assisted). Demographic and clinical characteristics, as well as surgeon and hospital characteristics and practice settings associated with the performance of vaginal hysterectomy, were estimated using multivariable models. To examine trends in the route of hysterectomy for benign indications, we plotted a trajectory to 2030 estimated from the vector autoregressive moving average processes model. RESULTS: A total of 1,558,107 patients—including 852,356 (54.7%) who underwent minimally invasive hysterectomy, 472,234 (30.3%) who underwent abdominal hysterectomy, and 233,517 (15.0%) who underwent vaginal hysterectomy—were identified. The rate of vaginal hysterectomy declined from 22.6% in January 2006 to 8.3% in December 2020. Vaginal hysterectomy was more commonly performed in hospitals with a high volume of prolapse and incontinence cases and by surgeons who performed a high number of hysterectomies for prolapse and incontinence and who are high-volume. The rate of vaginal hysterectomy was projected to decline to 7.3% by January 2030. By January 2030, vaginal hysterectomy was estimated to be used in 11.9% of patients undergoing hysterectomy for prolapse and in 3.5% of hysterectomies for other indications. For all indications, a minimally invasive hysterectomy will be the most common route of surgery. CONCLUSION: The performance of vaginal hysterectomy has declined substantially and is expected to fall to fewer than 8% of hysterectomies by 2030.