The Role of Surgeon Volume in the Relationship Between Race and Surgical Modality for Hysterectomy for Benign...

Racial disparities in access to minimally invasive surgery remain poorly understood. The objective of this analysis is to examine whether surgeon volume is a determinant in the relationship between patient race and surgical modality for hysterectomy for benign indications.

Using data from the Premier Healthcare Database, a retrospective analysis was conducted to identify adults (aged 18 years or older) who underwent hysterectomy for benign indications between 2016 and 2023 and who were non-Hispanic Black or non-Hispanic White. Multivariable logistic regression was used to model the associations among race, surgeon volume, and surgical modality (minimally invasive vs abdominal). Structural equation modeling with bootstrapping was used to examine whether surgeon volume was a significant determinant of the relationship between race and surgical modality.

A total of 367,593 patients were identified, of whom 296,455 (80.6%) were White and 71,138 (19.4%) were Black. We found that Black patients had 46% greater odds of being treated by a low-volume surgeon than White patients (odds ratio [OR] 1.46, 95% CI, 1.42-1.50). Patients who were treated by a low-volume surgeon had 2.2 times greater odds of having an abdominal procedure than patients seen by non-low-volume surgeons (OR 2.24, 95% CI, 2.17-2.30). The mediation analysis indicated that surgeon volume was a determinant ( P <.01) but only accounted for 2.7-3.1% of the relationship between race and surgical modality.

Although Black patients undergoing hysterectomy for benign indications are more likely to be treated by low-volume surgeons and undergo abdominal surgery, surgeon volume accounts for only a small percentage of this complex multifactorial health disparity.