OBJECTIVES: To compare the incidence of post-operative complications, healthcare utilization, and costs in laparoscopic supracervical hysterectomy (LSH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) patients. METHODS: Women >18 years with LSH or LAVH from 1/1/2007 - 9/30/ 2008 were identified in the Thomson Reuters MarketScan® Commercial Claims and Encounter Database. Patients were required to have 6 months of continuous medical and prescription coverage prior and subsequent to the hysterectomy date. Patients were excluded if they had a diagnosis of cancer, had index date procedure codes for both LSH and LAVH, or if the length of stay associated with the index procedure exceeded 20 days. Post-operative outcomes and gynecologic-related (GYN-related) utilization and costs were measured 30 and 180 days post-surgery. Multivariate analysis was conducted to compare post-surgical outcomes and costs between patients with LSH and LAVH controlling for demographic and clinical characteristics. RESULTS: A total of 6,198 LSH patients and 14,181 LAVH patients met the study criteria.  Compared with the LAVH cohort, LSH patients were more likely to have dysfunctional uterine bleeding (32.6% vs. 27.9%) and leiomyomas (38.0% vs. 26.3%) as their primary diagnosis and less likely to have endometriosis (9.3% vs. 10.4%) and prolapse (1.5% vs. 8.0%), p<0.01 in all cases; had significantly lower overall infection rates (6.2% vs. 7.4%, p=0.002); and had significantly lower total GYN-related costs ($252 vs. $385, p<0.001, 30 days post-surgery; $350 vs. $569, p<0.001, 180 days post-surgery). After multivariate adjustment for patient characteristics, total costs were estimated to be $108 and $174 lower for LSH patients than for LAVH patients within 30 and 180 days of follow up, respectively (p<0.001). LSH patients had significantly lower hazards of developing infection (hazard ratio [HR]=0.830), hematologic complication (HR=0.667), and analgesic use (HR=0.812). CONCLUSIONS: LSH patients demonstrated fewer post-operative infections and lower GYN-related costs compared to LAVH patients.