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High-Volume Surgeons and Reducing Racial Disparities in Route of Hysterectomy
Annie N Apple1, Lakeisha Mulugeta-Gordon2, Mary Deagostino-Kelly1
1Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James).
Study Objective:
To examine racial disparities in route of hysterectomy and perioperative outcomes before and after expansion of high-volume minimally invasive surgeons (>10 minimally invasive hysterectomies [MIHs]/year).
Design:
Retrospective cohort study.
Setting:
Multicenter academic teaching institution.
Patients:
All patients who underwent a scheduled hysterectomy for benign indications during 2018 (preintervention) and 2022 (postintervention).
Interventions:
Recruitment of fellowship in minimally invasive gynecologic surgery-trained faculty and increased surgical training for academic specialists in obstetrics and gynecology occurred in 2020.
Measurements And Main Results:
Patients in the preintervention cohort (n = 171) were older (median age, 45 years vs 43 years; p = .003) whereas patients in the postintervention cohort (n = 234) had a higher burden of comorbidities (26% American Society of Anesthesiologists class III vs 19%; p = .03). Uterine weight was not significantly different between cohorts (p = .328). Between the pre- and postintervention cohorts, high-volume minimally invasive surgeons increased from 27% (n = 4) to 44% (n = 7) of those performing hysterectomies within the division and percentage of hysterectomies performed via minimally invasive route increased (63% vs 82%; p <.001). In the preintervention cohort, Black patients had a lower percentage of hysterectomies performed via minimally invasive route than White patients (Black = 56% MIH vs White = 76% MIH; p = .014). In the postintervention cohort, differences by race were no longer significant (Black = 78% MIH vs White = 87% MIH; p = .127). There was a significant increase (22%) in MIH for Black patients between cohorts (p <.001). After adjusting for age, body mass index, American Society of Anesthesiologists class, previous surgery, and uterine weight, disparities by race were no longer present in the postintervention cohort. Perioperative outcomes including length of stay (p <.001), infection rates (p = .002), and blood loss (p = .01) improved after intervention.
Conclusion:
Increasing fellowship in minimally invasive gynecologic surgery-trained gynecologic surgeons and providing more opportunities in robotic/laparoscopic training for academic specialists may improve access to MIH for Black patients and reduce disparities.
