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To evaluate the differences in surgical approaches to hysterectomy by race and ethnicity using a nationally representative sample inclusive of all payers and patient encounters that accounts for geographic differences.
Materials and Methods
This cross-sectional study uses the Healthcare Cost and Utilization Project National Inpatient Sample, a comprehensive national database of inpatient encounters that includes all payers and includes a demographically and geographically representative sample within the United States. Race and ethnicity are patient reported. Abdominal, laparoscopic, and vaginal hysterectomies are identified using procedural codes. Differences in rates of open versus minimally invasive hysterectomies are analyzed by racial groups and adjusted for potential confounders including geographic regions.
In 2017, 35,865 patients underwent hysterectomy in this nationally representative sample, with 18,943 (55%) White, 7,472 (22%) Black, 5,244 (15%) Hispanic, 1,472 (4.2%) Asian, 165 (0.5%) Native American, and 1,390 (4.0%) other races. Overall, 72% of patients underwent abdominal hysterectomy, with the highest rate in Black women (83%, P<0.001); 12% of patients underwent laparoscopic hysterectomy, with the lowest rate in Black women (8.2%, P<0.001); and 6.9% of patients underwent vaginal hysterectomy, with the lowest rate in Black women (3.1%, P<0.001). These differences remained after controlling for patient characteristics, comorbidity, hospital characteristics, census divisions, metropolitan areas, and payers: Black (aOR 1.9, 95% CI 1.8-2.1, P<0.001), Hispanic (aOR 1.1, 95% 1.0-1.2, P=0.01), and Asian (aOR 1.7, 95% CI 1.5-2.0) women were more likely to have abdominal hysterectomies. Black race remained a significant predictor of abdominal hysterectomy in the multivariate analysis even among patients with a diagnosis of prolapse (adjusted OR 1.6, 95% CI 1.2-2.1, P=0.001).
Black, Hispanic, and Asian women had higher rates of open abdominal hysterectomy and lower rates of laparoscopic hysterectomy in a nationally representative sample controlling for not only patient characteristics, but also potential biases in practice patterns across geographic areas, payers, and hospital factors.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Rui Wang: Nothing to disclose; Elena Tunitsky: Nothing to disclose.