Social determinants of access to minimally invasive hysterectomy: reevaluating the relationship between race and route of hysterectomy for benign disease

Abstract

When accounting for the effect of numerous pertinent demographic and clinical factors, the odds of undergoing minimally invasive hysterectomy were diminished in women of Hispanic ethnicity and in those enrolled in Medicaid but were not discrepant along racial lines. However, both racial and socioeconomic disparities were observed with respect to access to robot-assisted hysterectomy despite the availability of robotic assistance in all hospitals treating the study population. Strategies to ensure equal access to all minimally invasive routes for all women should be explored to align delivery of care with the evidence supporting the broad implementation of these procedures as safe, cost-effective, and highly acceptable to patients.

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

“…7 In another study by Price et al, a small sample size of patients from three hospitals with high rates of minimally invasive hysterectomy found that black women did not have increased odds of having an open hysterectomy when controlling for other factors, including uterine size. 6 The findings of Price et al, suggest that access to care and quality of hospital care may be important factors to explore.…”

“…Several recent papers suggesting disparities in the route of hysterectomy have utilized secondary datasets that do not account for differences in patient populations. 6–8 In particular, black women have two to three times risk of developing uterine fibroids and, as a result, may have larger uteri, which could contribute to higher rates of open hysterectomies. 9 Additionally, black women have higher rates of co-morbidities, such as obesity, diabetes, and hypertension, which may also contribute to higher rates of open hysterectomy.…”

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

“…In another study using a nationwide database that included more than 15 000 patients who underwent a hysterectomy, black women were twice as likely to undergo an abdominal hysterectomy, even after controlling for clinical factors including body mass index, previous surgeries, and uterine size [10]. In contrast, in a study at an academic health system, authors found that controlling for pertinent patient-level factors mitigated the racial disparity in minimally invasive hysterectomy [11]. A comprehensive description that takes into account the granular patient, provider, and hospital factors that influence this disparity is not yet available.…”

Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer

“…6 9 10 Whether the trends seen in Original research stage I uterine cancer are reflected in stage II disease is unknown and requires further research, particularly because randomized controlled trials are not feasible to perform given the relatively low incidence of stage II uterine cancer. [10][11][12] Using the National Cancer Database, we evaluated the 5-year overall survival after open, laparoscopic-assisted, and roboticassisted hysterectomy in a large cohort of patients with locally advanced stage II uterine cancer. In addition, we assessed the trends of surgery in stage II uterine cancer based on race, ethnicity, insurance status, and other socio-economic factors to evaluate whether disparities exist in this study population.…”