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Racial Disparities in Minimally Invasive Benign Hysterectomy
Kamran Hessami1, Marie-Claire Leaf2, Jinxiao Liang2
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas. (Dr. Hessami).
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|January 3, 2025
Summary
Racial and ethnic minorities face significant disparities in accessing minimally invasive surgery (MIS) for hysterectomy. These groups also experience higher surgical complication rates compared to white patients, highlighting a critical gap in equitable care.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Health Equity
Background:
- Racial and ethnic disparities in surgical care access and outcomes are understudied.
- Minimally invasive surgery (MIS) offers potential benefits, but its utilization varies across demographics.
- Understanding these disparities is crucial for improving equitable healthcare delivery.
Purpose of the Study:
- To compare the rate of MIS utilization for benign hysterectomy among non-Hispanic white, Black, and Hispanic patients in the U.S.
- To assess surgical morbidity (complication risk) based on race and hysterectomy approach.
- To identify and quantify racial and ethnic disparities in MIS access and surgical outcomes.
Main Methods:
- Meta-analysis of 13 studies including over 1.1 million benign hysterectomy cases.
- Comparison of MIS utilization rates stratified by race and ethnicity.
- Analysis of surgical morbidity using the Clavien-Dindo Classification.
- Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Main Results:
- Black and Hispanic patients showed significantly lower rates of MIS utilization compared to white patients (OR 0.44 and 0.65, respectively).
- Adjusted analyses confirmed lower MIS use in nonwhite populations.
- Nonwhite patients faced higher risks of surgical complications, both with MIS (OR 1.32) and open hysterectomy (OR 1.56).
Conclusions:
- Striking racial and ethnic disparities exist in MIS utilization for benign hysterectomy in the U.S.
- Nonwhite patients have reduced access to MIS and experience greater surgical morbidity.
- Addressing these disparities is essential for achieving equitable surgical care.
