Black Race and Racism Affect Likelihood of Undergoing Surgery After Referral to a Minimally Invasive Gynecologic Surgeon [ID: 1377814

Abstract

INTRODUCTION: Significant racial and ethnic disparities persist in access and outcomes for patients with benign gynecologic disorders. The role of sociodemographic factors in surgical delays after referral to a minimally invasive gynecologic surgery (MIGS) specialist is unknown. METHODS: A retrospective cohort study of patients who completed a MIGS consultation at a single, large academic hospital between March 2015 and July 2016 (n=1,110) was performed. Logistic regression was used to assess effect of age, self-reported race and ethnicity, primary language, and insurance type on likelihood of surgical intervention within 12 months of consultation. RESULTS: Of patients undergoing surgery, the average wait time after consultation was 86 days (SD 69). Black patients had 2.6 times the odds of having surgery within 12 months of consultation (odds ratio [OR] 2.6, 95% CI 1.96–3.47) compared to White patients. Patients with Medicare had lower odds of completing surgery (OR 0.4, 95% CI 0.21–0.72) compared to those with other insurance or no insurance. Age, ethnicity, and primary language were not found to be correlated with surgical intervention. CONCLUSION: Race was found to be independently associated with likelihood of surgical intervention. Black patients in our study had more than twice the odds of having surgery compared to White patients, irrespective of age, ethnicity, primary language, or insurance. This may be due to more advanced disease at time of presentation secondary to care delays as well as surgeon bias in more readily pursuing surgery for Black patients, both of which stem from racism.