Age-related patterns in hysterectomy: indications and surgical route selection in a three-year tertiary-center cohort

BACKGROUND:
Hysterectomy indications and surgical route selection may vary with age due to shifting case mix.


OBJECTIVES:
To describe age-stratified hysterectomy indications and routes and identify factors independently associated with route selection.


DESIGN:
Retrospective chart review


SETTINGS:
Single-center, tertiary-care teaching and research hospital, Department of Obstetrics and Gynecology.


METHODS:
Hysterectomies performed for benign or premalignant indications between 2022 and 2024 were identified and verified. Patients were grouped according to age [<50, 50–59, or ≥60 years]. Indications were assigned using PALM–COEIN and grouped clinically. Routes were categorized as open abdominal, laparoscopic/VNOTES, or vaginal. Comparisons used Kruskal–Wallis and chi-square tests. Multinomial and binary logistic regression adjusted for age group, parity, comorbidity, smoking, and prior pelvic/abdominal surgery.


MAIN OUTCOME MEASURES:
age-stratified hysterectomy route and age-stratified indications and predictors of minimally invasive versus open surgery.


SAMPLE SIZE:
769 hysterectomies


RESULTS:

Primary indications differed significantly by age group (
P
<.001; Cramer's V=0.38): treatment-resistant abnormal uterine bleeding predominated in patients <50 and 50–59 years, whereas pelvic organ prolapse predominated in patients ≥60 years. Surgical route also varied by age (
P
<.001; Cramer's V=0.34): open abdominal hysterectomy decreased from 47.3% in patients <50 years to 15.3% in those ≥60 years, while vaginal hysterectomy increased from 4.0% to 52.6%. In multinomial regression, age ≥60 years was associated with higher odds of laparoscopic/VNOTES versus open surgery (aOR 1.97, 95% CI 1.08–3.61) and vaginal versus open surgery (adjusted odds ratio, aOR 21.60, 95% confidence interval, CI 10.02–46.60). In binary regression, age ≥60 years (aOR 4.18, 95% CI 2.41–7.26) and parity (aOR 1.18 per birth, 95% CI 1.06–1.32) favored minimally invasive surgery.



CONCLUSIONS:
Age-related indication shifts accompanied major route changes, with greater vaginal and minimally invasive use among older patients.


LIMITATIONS:
Single-center retrospective design; residual confounding by indication and uterine size; conversions and standardized complications were not analyzed; unmeasured clinical/surgeon factors.