Racial and Ethnic Disparities in Hysterectomies for Leiomyomas by Surgical Approach [31B

Abstract

INTRODUCTION: Overall, minority women are at higher risk of complications after hysterectomy. This is partly explained by lower utilization of minimally invasive hysterectomy and higher prevalence of leiomyomas. Our objective was to evaluate the association between race/ethnicity and postoperative complications among patients undergoing abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) specifically for leiomyomas. METHODS: Using the American College of Surgeons National Quality Improvement Program database 2014–2017, we identified 20,133 women who underwent non-emergent hysterectomy for leiomyomas. Using multivariate logistic regression, we estimated odds ratios (OR) and 95% confidence intervals controlling for age, body mass index, comorbidities, uterine weight, prior abdominal/pelvic surgeries, and concomitant surgical procedures. IRB approval was waived. RESULTS: Black women were more likely to experience complications for AH (aOR 1.54 [1.32–1.80]) and LH (aOR 1.38 [1.17–1.64]), but not for VH (aOR 1.44 [0.92–2.28]) compared to white women. Hispanic women were more likely to receive blood transfusions when undergoing AH (aOR 1.43 [1.07–1.91]) or LH (aOR 2.17 [1.37–3.45]), but their risk of total complications was not different from white women for any surgical approach, and they were less likely than their white counterparts to experience major complications when undergoing VH (aOR 0.27 [0.08–0.89]). Compared to white women, the mean length of stay is higher for black women undergoing AH or LH, and the mean total operation time is higher for all minority groups (including Asian/Other) regardless of surgical approach. CONCLUSION: Significant racial/ethnic disparities exist among women undergoing hysterectomy for leiomyomas via the abdominal and laparoscopic approaches but not vaginal.