Access to Minimally Invasive Gynecologic Surgery for Adnexal Surgery: Impact of Race and Payer Mix

Abstract

Study Objective To determine racial and social disparities regarding adnexal surgery. Design Retrospective cohort. Setting Data was obtained from the Statewide Planning and Research Cooperative System (SPARCS) for New York State. The database was reviewed from 2011 - 2015 for ovarian cystectomy with or without salpingectomy for benign indications. Patients or Participants There were 68,029 patients included in this analysis. Average age was 43 years, with 81.3% between 18-55 and 17.7% older than 55. Racial composition comprised of 68.7% Caucasian, 4.8% Asian, 11.2% Black, and 15.3% as other. Payor mix included 79.6% insured, 7.4% Medicaid, 8.3% Medicare, and 4.7% other or self-payment. Majority resided in metropolitan areas (90.6%) and did not travel greater than 15 miles for care. Interventions Adnexal surgery performed via laparotomy or laparoscopy. Measurements and Main Results Of the 68,029 patients included, 54,829 were performed via laparoscopy (80.6%) while 13,200 were via laparotomy (19.4%). Compared to Caucasian, odds ratio of having a laparoscopy was 0.68 for Black, 0.81 for Hispanic, and 0.80 for other. Compared to commercial insurance, odds ratio of having a laparoscopy was 0.69 for Medicaid, 0.72 for Medicare, 0.92 self. At high-volume surgical facilities, the odds ratio for utilizing laparoscopy was 1.83 compared to low volume facilities and 1.49 compared to medium volume facilities. At institutions with major teaching affiliation, the odds ratio was 0.91 compared to non-teaching and 1.0 for minor affiliation. Conclusion Race is not the only factor associated with a lower likelihood of laparoscopy for adnexal surgery. Other factors such as institution type and payer mix also impact likelihood.