Racial and Ethnic Disparities in Utilization of Minimally-Invasive Hysterectomy

Abstract

<h3>Study Objective</h3> Minimally-invasive hysterectomy has significant advantages over laparotomy, including decreased complications, faster recovery time, and improved patient satisfaction. Studies have reported an increased risk of open surgery among Black patients compared with white patients. Some have proposed that patient factors, such as BMI, fibroids, and uterine weight, may explain this difference. We sought to explore these influences using a large national data set. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> 722 academic or community-based hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. <h3>Patients or Participants</h3> Patients undergoing hysterectomy from 2014-2020. <h3>Interventions</h3> Patients undergoing benign hysterectomy were identified by CPT code; 48.7% had a precise uterine weight. We used log-binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI). <h3>Measurements and Main Results</h3> Among 360,460 patients who underwent benign hysterectomy, 56.4% were white, 14.1% Black, 10.6% Hispanic and 18.9% other or unknown race or ethnicity. Black patients were twice as likely as white patients to undergo open hysterectomy than minimally-invasive (RR 2.19 [95% CI 2.16-2.23]). Hispanic patients and patients with other/unknown race or ethnicity also were more likely than white patients to undergo open hysterectomy (Hispanic RR 1.48 [95% CI 1.45-1.51], other/unknown RR 1.75 [95% CI 1.73-1.78]). These estimates were unchanged when controlling for age, BMI, diabetes and smoking. When controlling for uterine weight among 175,388 patients, the RRs were attenuated, though still significantly higher for all racial and ethnic groups compared to white patients (Black RR 1.29 [95% CI 1.26-1.31], other/unknown RR 1.33 [95% CI 1.31-1.36], Hispanic RR 1.29 [95% CI 1.26-1.32]). <h3>Conclusion</h3> Race and ethnicity appear to influence route of hysterectomy independent of factors such as BMI and uterine weight. Possible other influences include differing access to skilled surgeons who can provide complex minimally-invasive surgery, and racial discrimination by providers or health systems.