Introduction Hysterectomies have become one of the most performed procedures in the United States with one in nine women undergoing a hysterectomy in their lifetime, mostly for benign gynecologic indications. Currently, the American College of Obstetrics (ACOG) recommends performing vaginal hysterectomies over laparoscopic, citing faster return to work, association with greater patient satisfaction, shorter operating times, and lower costs. However, there is a paucity of comprehensive cohort studies examining postoperative outcomes and mortality differences between vaginal and laparoscopic hysterectomies.

Materials and Methods A retrospective cohort study was conducted using information from the National Surgical Quality Improvement Program database (NSQIP). Women aged 18 to 65 who underwent vaginal or laparoscopic hysterectomies for benign indications between 2018 and 2021 were reviewed. Outcome variables included mortality or presence of a major postoperative complication, including surgical site infections, urinary tract infection, sepsis, and serious systemic events. Unadjusted and adjusted (multiple binary logistic regression) odds ratios and 95% confidence intervals were computed.

Results The sample in this study consisted of 157,628 women. Of these women, 87% underwent laparoscopic hysterectomy and vaginal hysterectomy was performed on the remaining 13%. The incidence of the composite outcome was higher among patients who underwent vaginal hysterectomy (6.4%) compared to laparoscopic hysterectomy (4.1%), (adjusted OR 1.66; 95% CI 1.56-1.76).

Conclusions Laparoscopic hysterectomies have lower rates of postoperative complications and mortality. The findings of our study suggest that laparoscopic hysterectomies are just as effective and likely safer than vaginal hysterectomies. This indicates a potential need to reevaluate the ACOG's current recommendations.