Residents at Inner-City Academic Centers May Fail to Meet the New Minimally Invasive Hysterectomy Requirements [14P

Abstract

INTRODUCTION: The ACGME and ACOG promote the use of minimally invasive approaches for hysterectomy. In 2018, the ACGME Ob/Gyn Residency Review Committee increased the number of minimally invasive (MIS) hysterectomies required for trainees to graduate residency. Historically, inner-city black women have higher rates of fibroid disease and other medical co-morbidities that may exclude MIS as the safest mode for hysterectomy. METHODS: Retrospective cohort study using the 2016 hysterectomy-specific National Surgical Quality Improvement Program (NSQIP) database. Demographics, comorbidities and surgical characteristics were examined by hysterectomy type. The association between race and hysterectomy type was investigated using one and two-way analysis of variance (ANOVA). RESULTS: In 2016, 20,770 hysterectomies for benign indications were identified. Across all races, 25.7% underwent abdominal hysterectomy, 57.4% underwent laparoscopic hysterectomy and 16.9% underwent vaginal hysterectomy. Black women were more likely than white women to undergo open abdominal hysterectomy (41.4% vs 20.1%, respectively, P<0.001). After adjusting for uterine weight (0-100 g, 100-250 g, and >250 g), black women were still more likely to undergo abdominal hysterectomy compared to other races (P<0.001). Additionally, when adjusting for history of prior abdominal or pelvic surgeries, black women were more likely to undergo abdominal hysterectomy compared to other races (P<0.001). CONCLUSION: Black women disproportionately undergo higher rates of abdominal hysterectomy compared to other racial groups. Trainees at academic medical centers with a higher proportion of black patients may fail to meet the number of minimally invasive hysterectomies required for graduation. Further efforts to identify the etiology of racial disparities in route of hysterectomy should be pursued.