Abstract PO-230: Racial differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States

Abstract

Abstract Introduction: Opportunistic salpingectomy (OS), the removal of the fallopian tubes during benign gynecologic surgery, has been rapidly adopted by clinicians in the U.S. as a strategy for ovarian cancer prevention. However, little is known about racial differences in OS adoption. As with other medical innovations, surgical innovations in gynecology may be adopted differentially across racial groups, exacerbating disparities in care quality. We examined racial differences in OS adoption in a population-based sample of inpatient and outpatient surgeries. Methods: A cohort of 809,911 women aged 18-50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011-2018 was identified using the Premier Healthcare Database, a large geographically diverse all-payer insurance claims database including over 600 acute care hospitals across the U.S. OS adoption was examined by race/ethnicity (non-Hispanic white [NHW], non-Hispanic Black [NHB], Hispanic, other) using multivariable-adjusted log-binomial regression models accounting for hospital-level clustering. Models included a race/ethnicity by year of surgery (2011-2013 [before guideline] vs. 2014-2018 [after guideline]) interaction term to test whether racial differences in OS adoption changed with the release of national guidelines supporting OS use. Results: From 2011-2018, 104,276 hysterectomy and OS (NHW: 60.1%, NHB: 18.8%, Hispanic: 11.4%, other: 9.7%) and 28,015 OS for sterilization (NHW: 65.4%, NHB: 10.0%, Hispanic: 10.6%, other: 14.0%) were performed. The proportion of benign hysterectomy procedures involving OS increased from 6.4% in 2011 to 62.3% in 2018, and the proportion of sterilization procedures involving OS increased from 0.7% in 2011 to 19.1% in 2018. After adjusting for demographic, clinical, procedural, and hospital/provider characteristics, NHB (risk ratio [RR]: 0.97; 95% CI: 0.95-0.99) and Hispanic women (RR: 0.84; 95% CI: 0.77-0.92) were significantly less likely to undergo hysterectomy and OS than NHW women. A significant interaction between race/ethnicity and year of surgery was noted in NHBs compared to NHWs, with a lower likelihood of hysterectomy and OS in NHBs undergoing surgery before but not after national guideline release (RR2011-2013: 0.82; 95% CI: 0.75-0.89; RR2014-2018: 0.99; 95% CI: 0.96-1.01). Results were similar in stratified analyses by hysterectomy route (abdominal, laparoscopic, vaginal). NHBs were also significantly less likely to undergo OS for sterilization than NHWs (RR: 0.84; 95% CI: 0.81-0.88), with no differences by year of surgery. Conclusions: Although OS for ovarian cancer prevention has been rapidly adopted into clinical practice in the U.S., our findings suggest that its adoption has not been equitable across racial groups. NHB and Hispanic women are less likely to undergo OS than NHW women even after adjusting for demographic, clinical, procedural, and hospital/provider characteristics. If these differences in OS adoption persist, disparities in ovarian cancer incidence may worsen in the future. Citation Format: Pritesh S. Karia, Yongmei Huang, Parisa Tehranifar, Kala Visvanathan, Jason D. Wright, Jeanine M. Genkinger. Racial differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-230.