The laparoscopic approach is more preferred among nurses for benign gynecologic conditions than among nonmedical working women: A nationwide study in Taiwan

Objective: To compare the use of laparoscopy and laparotomy for hysterectomy in treating benign gynecological conditions in nurses and nonmedical working women. Materials and Methods: A nationwide population-based study was conducted using data from inpatient expenditures of Taiwan's National Health Insurance Research Datasets between 2008 and 2011. All women undergoing total hysterectomies via laparoscopy and laparotomy between the ages of 20 years and 65 years were identified. A generalized equation estimation model was used to compare the differences in laparoscopic hysterectomy (LH) and total abdominal hysterectomy (TAH) between the two groups. Results: There were 1226 nurses, and 36,624 nonmedical working women, serving as controls, in the present study. The LH rate, as compared to the TAH rate, was significantly higher among nurses than among controls (56% vs. 52%, p = 0.006). A multivariate analysis indicated that nurses were significantly more likely to undergo LH (odds ratio, 1.12; 95% confidence interval, 1.01-1.26) than TAH. Nurses were more often treated at medical centers or high-volume hospitals, and were more often treated by high-volume gynecologists. Conclusion: Compared to nonmedical working women, nurses are more likely to undergo LH rather than TAH. These differences may suggest the influence of medical knowledge and physician-patient interaction on the decision to undergo laparoscopy, in addition to patients' medical conditions.