The Association between Race and the Route of Hysterectomy: a Nationwide Analysis from 2018-2022
Abstract
Introduction and Objective. Current evidence suggests disparate utilization of minimally invasive surgery versus abdominal/open hysterectomies for managing benign gynecologic conditions in non-Hispanic black women compared to their non-Hispanic white counterparts. However, there has yet to be a study assessing disparities in hysterectomy routes between non-Hispanic white and non-Hispanic black females throughout the nation. Study aim: To assess whether there are nationwide disparities between non-Hispanic black and non-Hispanic white women concerning the route of hysterectomy undergone in US women treated for non-malignant conditions. Methods. A secondary analyses of data was conducted using data from the National Surgical Quality Improvement Program (NSQIP) database years 2018 to 2022. We compared non-Hispanic black and non-Hispanic white females, aged 18 and above, with uterine weights ranging from 30-250g regarding route of hysterectomy: if minimally invasive hysterectomy (MIH), including vaginal and laparoscopic routes), or non-minimally invasive (abdominal) hysterectomy. We estimated crude and adjusted odds ratio (OR) and corresponding 95% confidence intervals. Confounders adjusted for included age, BMI, ASA classification, history of bleeding disorders, if surgery was an emergency, and history of prior abdominal or abdominal operations. SPSS was used for analyses. Significant results were considered for p-values ≤0.05. Results. A total of 11,065 women was studied, of which 16.4% were black. Overall, 44% had MIH. In the unadjusted analyses, the odds of minimally invasive hysterectomies were 43% lower in black women compared to their white counterparts (OR: 0.57, 95% CI: 0.51-0.63). Following adjustments, the odds of minimally invasive hysterectomies were 37% lower in black women compared to white women (OR: 0.63, 95% CI: 0.56-0.69). Conclusions-Implications. We found evidence for nationwide racial disparities hysterectomies procedures: Black women were less likely to undergo MIH procedures. Future studies should investigate if the reasons for such disparities are biological or a result of racial biases. Such knowledge could highlight the need for further awareness of implicit biases and help to enhance healthcare equity, improve patient outcomes, and inform policy decisions.
Keywords
hysterectomy, minimally invasive hysterectomy, minimally invasive surgery, laparoscopic hysterectomy, total abdominal hysterectomy
Presentation Type
Poster Presentation
The Association between Race and the Route of Hysterectomy: a Nationwide Analysis from 2018-2022
Introduction and Objective. Current evidence suggests disparate utilization of minimally invasive surgery versus abdominal/open hysterectomies for managing benign gynecologic conditions in non-Hispanic black women compared to their non-Hispanic white counterparts. However, there has yet to be a study assessing disparities in hysterectomy routes between non-Hispanic white and non-Hispanic black females throughout the nation. Study aim: To assess whether there are nationwide disparities between non-Hispanic black and non-Hispanic white women concerning the route of hysterectomy undergone in US women treated for non-malignant conditions. Methods. A secondary analyses of data was conducted using data from the National Surgical Quality Improvement Program (NSQIP) database years 2018 to 2022. We compared non-Hispanic black and non-Hispanic white females, aged 18 and above, with uterine weights ranging from 30-250g regarding route of hysterectomy: if minimally invasive hysterectomy (MIH), including vaginal and laparoscopic routes), or non-minimally invasive (abdominal) hysterectomy. We estimated crude and adjusted odds ratio (OR) and corresponding 95% confidence intervals. Confounders adjusted for included age, BMI, ASA classification, history of bleeding disorders, if surgery was an emergency, and history of prior abdominal or abdominal operations. SPSS was used for analyses. Significant results were considered for p-values ≤0.05. Results. A total of 11,065 women was studied, of which 16.4% were black. Overall, 44% had MIH. In the unadjusted analyses, the odds of minimally invasive hysterectomies were 43% lower in black women compared to their white counterparts (OR: 0.57, 95% CI: 0.51-0.63). Following adjustments, the odds of minimally invasive hysterectomies were 37% lower in black women compared to white women (OR: 0.63, 95% CI: 0.56-0.69). Conclusions-Implications. We found evidence for nationwide racial disparities hysterectomies procedures: Black women were less likely to undergo MIH procedures. Future studies should investigate if the reasons for such disparities are biological or a result of racial biases. Such knowledge could highlight the need for further awareness of implicit biases and help to enhance healthcare equity, improve patient outcomes, and inform policy decisions.