Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy

Abstract

Objective: To estimate the associations between race, route of hysterectomy and postoperative complications among women undergoing benign hysterectomy. Methods: A cohort study was performed. All patients undergoing benign hysterectomy, recorded in the National Surgical Quality Improvement Program (NSQIP) and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression. Results: Of 15,136 women who underwent benign hysterectomy, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs. 22.9%; OR: 3.36, 95%CI: 3.11–3.64). Black women had larger uteri (median 262g vs. 123g; 60.7% vs. 25.6% with uterus >250g), more prior pelvic surgery (58.5% vs. 53.2%) and higher BMIs (32.7 vs. 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (aOR: 2.02, 95%CI: 1.85–2.20). Black women experienced more major complications than white women (4.1% vs. 2.3%; p<0.001) and more minor complications (11.4% vs. 6.7%; OR: 1.78, p<0.001). Again these disparities persisted with adjustment (major aOR: 1.56, 95%CI: 1.25–1.95; minor aOR: 1.27, 95%CI: 1.11–1.47). Conclusions: Back women have a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

“…Studies, including our prior work, have reported that non-White women, and Black women in particular, are less likely to undergo MIGS [5,[9][10][11][12] and have worse post-operative outcomes, even after controlling for surgical approach [5,[9][10][11]. It is possible, however, that reported differences in outcomes can be explained, at least partially, by pre-existing conditions not controlled for in prior studies and hospital factors not accounted for.…”

National trends in inpatient endometriosis admissions: Patients, procedures and outcomes, 2006−2015

“…Prior research suggests women with fewer resources and more comorbidities are more likely to receive a hysterectomy [28]. Further, there is compelling evidence that patients with higher income, private insurance, and white race are more likely to undergo laparoscopic hysterectomy versus open hysterectomy [19,21,29]. These trends are increasingly visible in inpatient endometriosis care.…”

“…Slow but steady response to this recommendation is evident; for example, the share of hysterectomies performed laparoscopically increased from 10% in 1997 to 29% in 2010 and 43% in 2013 [18–20]. A recent study of the American College of Surgeons National Surgical Quality Improvement Program database found that 30% of recorded hysterectomies for benign indications in 2015 were abdominal, while 16% were vaginal and 55% were laparoscopic [21]. The move towards minimally invasive gynecologic surgery has led to a greater proportion of outpatient procedures, shorter hospital stays, fewer complications, and faster recovery for patients [22], though inpatient surgery remains necessary for some patients.…”

Racial Disparities in Route of Hysterectomy for Benign Indications Within an Integrated Health Care System

“…This study found that racial disparities in MIH no longer persisted within this integrated health care system, unlike in other settings within the United States. 1,5,6 The study by Alexander et al 5 found that African American individuals were approximately twice as likely to undergo open abdominal hysterectomies vs MIHs compared with their white counterparts. The study by Pollack et al 6 demonstrated that despite increasing annual laparoscopic rates, racial/ethnic minority women were less likely to undergo MIH.…”

“…Our results may be due to system changes. 4,5 Our initiative increased MIH rates and the proportion of high-volume surgeons while simultaneously reducing the surgeon pool. With these system changes, we observed a reduction of racial disparities in MIH.…”