OBJECTIVES: Examine trends of surgical routes and outpatient and inpatient setting of care for benign hysterectomy in the U.S. from 2008-2014. METHODS: Utilizing the Premier Hospital Perspective® from 2008 - 2014, we examined all women with age≥18 who underwent benign hysterectomies.  Those hysterectomies performed for female genital cancer, pelvic or lower abdominal trauma, pregnancy, childbirth, and puerperium were excluded.   Four surgical routes were identified by ICD-9 codes: abdominal (AH), vaginal (VH), laparoscopic (LH), and robotic (RH). Surgical route rates were calculated quarterly and trend tests were performed.  Secondary stratified analyses included inpatients vs. outpatients care settings and patients with complexities ≥2. RESULTS: Surgical routes of RH and LH increased, accompanied with decreased VH and AH from 2008 to 2014. In 2008Q1, 49.51% were AH, 21.17% VH, 27.64% LH, and 1.67% RH; in 2014Q4, 28.05% were AH, 13.62% VH, 37.96% LH, and 20.37% RH. The shift of the procedure to outpatient was significant: 13.27% were among outpatient visits in 2008 vs. 57.53% in 2014. Among outpatient visits, RH increased from 3.61% to 28.67%, while LH decreased from 68.62% to 54.33% and VH from 24.80% to 15.89%. For those with ≥ 2 complexities, RH increased from 10.87% to 39.29%, and LH decreased from 78.26% to 56.04%. In providers where RH was adopted during 2008-2014 and thus all four routes were available, RH increased from 28.48% to 48.20% and LH decreased from 55.08% to 39.79% for outpatient surgical visits.  CONCLUSIONS: Rates of RH and LH significantly increased from 2008 - 2014, associated with decreases in AH and VH, and a significant shift from inpatient to outpatient surgeries.  Outpatient RH and outpatient complex RH increased significantly compared to decreases in LH and VH.