Disparities in Access to Minimally Invasive Hysterectomy in a Suburban Community Hospital: A Patient-Level Analysis

Abstract

Study Objective Prior studies have identified differences in access to minimally invasive hysterectomy (MIH) based on demographic characteristics. These differences do not always persist when including patient-level information that may affect surgical decision-making. This study aims to identify racial or ethnic differences in access to MIH (laparoscopic or robotic) at our institution, as well as trends in access over time. Design Retrospective cohort study. Setting Suburban community hospital. Patients or Participants All adult women undergoing hysterectomy for benign indications, January 2015– December 2019. Exclusion criteria were a preoperative diagnosis of pelvic malignancy, concurrent sacrocolpopexy, emergent hysterectomy, or vaginal hysterectomy. Interventions N/A Measurements and Main Results A total of 1,632 patients were included in the analysis. 54% were non-Hispanic white, 17% non-Hispanic black, 21% Hispanic of any race, and 8% Asian, Native American, Pacific Islander or self-identified as “other”. Black and Hispanic women were significantly less likely to undergo MIH than white women, OR 0.490 (CI 0.371 – 0.646, p Conclusion This study identified a disparity in likelihood of undergoing MIH for non-white women. This was eliminated for black and “other” women after controlling for patient-level information but persisted in Hispanic women. Further study is warranted to better understand the factors underlying this finding.