Practice-Level Severity Case Mix and Treatment Patterns for Premenopausal Noncancerous Hysterectomy

Area of Science:

• Gynecological surgery
• Health services research
• Health equity

Background:

• Hysterectomy for benign conditions is patient-preference-sensitive, leading to variations in symptom severity across practices.
• Understanding patient segregation by race, ethnicity, and insurance status in relation to practice-level symptom severity is crucial.

Purpose of the Study:

• To investigate if the severity of symptoms among patients undergoing hysterectomy for noncancerous conditions correlates with patient demographics (race, ethnicity, insurance status) across different clinical practices.

Main Methods:

• Analysis of 1,590 hysterectomy cases from 20 U.S. South practices (2014-2017).
• Development of symptom severity scores (bleeding, pain, bulk) from presurgical notes.
• Categorization of practices into lower or higher severity case mix groups.
• Log-binomial models to assess associations between practice severity and patient characteristics, adjusting for confounders.

Main Results:

• Practices with lower symptom severity case mix predominantly served privately insured patients (96%).
• Hispanic patients were less likely to have hysterectomies at lower severity practices (PR: 0.52).
• Publicly insured (PR: 0.13) and uninsured (PR: 0.28) patients were significantly less likely to receive hysterectomy at lower severity practices.

Conclusions:

• Significant disparities exist in hysterectomy care based on insurance status and race/ethnicity.
• Patients with public or no insurance, and nearly all Hispanic patients, were concentrated in higher symptom severity practices.
• This suggests a segregation of care, with vulnerable populations receiving hysterectomies in settings managing more complex cases.