Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018

Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology

“…Moreover, Asian/PI, AA, and Hispanic women are 5–12% less likely to receive a vaginal hysterectomy [18 ▪▪ ]. Similar findings have been replicated across the US [19 ▪ ].…”

“…The literature demonstrating racial disparities in route of hysterectomy and associated outcomes is robust, especially for AA compared to white women. One key finding to consider for future research and initiatives is that hospital MIS volume is the strongest predictor of undergoing an MIS hysterectomy [19 ▪ ]. Access to an MIS approach may be increased by implementing standardized pathways for determining route of hysterectomy [55] and prioritizing hiring practices that ensure the presence of high-volume gynecologic surgeons with experience in complex pathology [56,57].…”

“…Pollack et al found that hospitals serving a higher proportion of AA patients perform more abdominal hysterectomies across all races and ethnicities, fewer laparoscopic procedures for AA and Asian/PI women, and fewer vaginal hysterectomies across all ethnic groups when compared with hospitals serving majority non-AA patients [18 ▪▪ ]. Further, other studies have found that hospitals with lower total hysterectomy volumes have higher rates of abdominal hysterectomies [18 ▪▪ ,19 ▪ ,22]. These findings taken together indicate that treatment disparities are influenced by both procedural volume and the population served by the hospital.…”

Disparities in Benign Gynecologic Surgical Care

“…A retrospective analysis of factors associated with minimally invasive hysterectomy (MIH) in Illinois found hospital volume to be the single most important factor influencing the likelihood of undergoing a MIH, but a higher proportion of Black patients underwent hysterectomies at hospitals with a lower proportion of MIH. 15 A study examining disparities in access to care and outcomes for patients undergoing hysterectomy at high-volume hospitals in New York found that patients treated by low-volume surgeons were more often Black [19.4% vs. 14.3%; adjusted odds ratio (aOR) = 1.26; 95% confidence interval (CI), 1.09-1.46]. 2 The same study found that low-volume surgeons were also more likely to perform abdominal hysterectomy versus MIH (77.8% vs. 54.7%;…”

“…The volume-outcome relationship is also important when considering how it interacts with issues of equitable care and access to health care. A retrospective analysis of factors associated with minimally invasive hysterectomy (MIH) in Illinois found hospital volume to be the single most important factor influencing the likelihood of undergoing a MIH, but a higher proportion of Black patients underwent hysterectomies at hospitals with a lower proportion of MIH 15…”