8771 The Impact of Social Determinants of Health Delaying Treatment for Women That Undergo Hysterectomy for Abnormal Uterine Bleeding

Abstract

<h3>Study Objective</h3> 1) Identify the social determinants of health that contribute to delayed treatment for abnormal uterine bleeding (AUB), defined as women presenting with large uteruses at the time of hysterectomy, and patterns of healthcare utilization over a 3-year period and 2) Assess health-related outcomes in women with delayed hysterectomy for AUB. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Single hospital system. <h3>Patients or Participants</h3> 1,361 women who underwent hysterectomy for benign causes of abnormal uterine bleeding over a 3-year period between January 1, 2014, to December 31, 2017. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Women with enlarged uteri ≥ 500 g at time of hysterectomy were more likely to present to the emergency department (10.9% vs. 7.0%, p=0.034) and subspecialty care visits (34.2% vs. 28.0%, p=0.047). There were no differences in generalist gynecological visits among the two groups. Black women disproportionately composed those with enlarged uteri (59.9% vs. 36.1%, p=<0.001). There were no differences identified in age, BMI, socioeconomic status, ethnicity or insurance type. Women who delayed treatment for AUB were more likely to undergo mini-laparotomy (2.7% vs. 0.8%, p=0.01) or laparotomy (68.9% vs. 24.2%, p=<0.001) compared to minimally invasive approaches, demonstrated lower pre-operative hemoglobin levels (11.5 vs. 12.3, p=<0.001), lower hemoglobin levels in a 3-year period leading up to hysterectomy (10.0 vs. 11.3, p=<0.001), increased estimated blood loss (373.3mL vs. 178.7mL, p=<0.001), procedure time (171.9 min vs. 145.1min, p=<0.001) and length of hospital stay (1.4 days vs. 0.6 days, p=<0.001). <h3>Conclusion</h3> Delayed treatment for women who ultimately underwent hysterectomy for abnormal uterine bleeding was associated with increased emergency department and subspecialty care visits, and this population was disproportionately composed of Black woman. Perioperatively, delayed treatment was associated with more open surgeries, increased blood loss, increased operative time, and longer hospital stays.