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Racial Differences in Planned Hysterectomy Procedure Route.

Wan-Ting K Su1, Chad M Coleman1,2, Andrew S Bossick1

  • 1Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.

Journal of Women'S Health (2002)
|October 12, 2021
PubMed
Summary

Black women were initially less likely to have minimally invasive surgery (MIS) hysterectomies than White women. However, after accounting for factors like uterine weight and fibroids, this racial difference in MIS hysterectomy likelihood disappeared.

Keywords:
hysterectomyminimally invasive surgeryrace

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Area of Science:

  • Gynecology
  • Surgical Oncology
  • Health Services Research

Background:

  • Hysterectomy, a common gynecological procedure, can be performed via minimally invasive surgical (MIS) or abdominal (laparotomy) approaches.
  • Understanding potential racial disparities in surgical approach selection is crucial for equitable healthcare delivery.
  • Previous research suggests disparities may exist, but the influence of specific clinical factors requires further investigation.

Purpose of the Study:

  • To investigate racial differences in the likelihood of Black versus White women undergoing a planned minimally invasive surgery (MIS) hysterectomy.
  • To identify whether clinical confounders explain any observed racial disparities in hysterectomy approach.

Main Methods:

  • A prospective cohort study was conducted at Henry Ford Health System from October 2015 to August 2017.
  • Data included patient-reported demographics, insurance, validated questionnaires, and electronic health record clinical/operative characteristics.
  • Logistic and multinomial logistic regression models were used to analyze the association between race and surgical approach (MIS vs. abdominal, laparoscopic vs. abdominal, vaginal vs. abdominal).

Main Results:

  • Initially, Black women were significantly less likely than White women to have a planned MIS hysterectomy (OR=0.46, P<0.05), including laparoscopic (RRR=0.46, P<0.05) and vaginal (RRR=0.45, P=0.01) approaches.
  • After adjusting for uterine weight and indication (fibroids), these racial differences were no longer statistically significant (e.g., MIS vs. abdominal aOR=0.93, P=0.79).
  • Associations were not confounded by depression, financial distress, or decision satisfaction.

Conclusions:

  • Racial disparities in planned minimally invasive surgery (MIS) hysterectomy are not evident when controlling for key clinical confounders such as uterine weight and indication.
  • These findings highlight the critical importance of accounting for all significant confounding variables when examining racial differences in surgical outcomes.
  • Equitable access to MIS hysterectomy may be achieved by addressing clinical factors rather than race itself.