Background
Despite an estimated 10% prevalence of endometriosis among reproductive-age women,
surgical population-based data are limited.
Objective
We sought to investigate racial and ethnic disparities in surgical interventions and
complications among patients undergoing endometriosis surgery across the United States.
Study Design
We performed a retrospective cohort study of American College of Surgeons National
Surgical Quality Improvement Program data from 2010 to 2018 identifying International
Classification of Diseases, Ninth/Tenth Revision codes for endometriosis We compared
procedures, surgical routes (laparoscopy vs laparotomy), and 30-day postoperative
complications by race and ethnicity.
Results
We identified 11,936 patients who underwent surgery for endometriosis (65% White,
8.2% Hispanic, 7.3% Black or African American, 6.2% Asian, 1.0% Native Hawaiian or
Pacific Islander, 0.6% American Indian or Alaska Native, and 11.5% of unknown race).
Perioperative complications occurred in 9.6% of cases. After adjusting for confounders,
being Hispanic (adjusted odds ratio, 1.31; 95% confidence interval, 1.06–1.64), Black
or African American (adjusted odds ratio, 1.71; confidence interval, 1.39–2.10), Native
Hawaiian or Pacific Islander (adjusted odds ratio, 2.08; confidence interval, 1.28–3.37),
or American Indian or Alaska Native (adjusted odds ratio, 2.34; confidence interval,
1.32–4.17) was associated with surgical complications. Hysterectomies among Hispanic
(adjusted odds ratio, 1.68; confidence interval, 1.38–2.06), Black or African American
(adjusted odds ratio, 1.77; confidence interval, 1.43–2.18), Asian (adjusted odds
ratio, 1.87; confidence interval, 1.43–2.46), Native Hawaiian or Pacific Islander
(adjusted odds ratio, 4.16; confidence interval, 2.14–8.10), and patients of unknown
race or ethnicity (adjusted odds ratio, 2.07; confidence interval, 1.75–2.47) were
more likely to be open. Being Hispanic (adjusted odds ratio, 1.64; confidence interval,
1.16–2.30) or Black or African American (adjusted odds ratio, 2.64; confidence interval,
1.95–3.58) was also associated with receipt of laparotomy for nonhysterectomy procedures.
The likelihood of undergoing oophorectomy was increased for Hispanic and Black women
(adjusted odds ratio, 2.57; confidence interval, 1.96–3.37 and adjusted odds ratio,
2.06; confidence interval, 1.51–2.80, respectively), especially at younger ages.
Conclusion
Race and ethnicity were independently associated with surgical care for endometriosis,
with elevated complication rates experienced by Hispanic, Black or African American,
Native Hawaiian or Pacific Islander, and American Indian or Alaska Native patients.
Key words
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Article Info
Publication History
Published online: January 27, 2022
Accepted:
January 23,
2022
Received in revised form:
January 12,
2022
Received:
November 3,
2021
Footnotes
A.J.P. reports his role as a speaker for Allergan and receiving royalties from UpToDate.
No financial support was received for the funding of this study.
Cite this article as: Orlando MS, Luna Russo MA, Richards EG, et al. Racial and ethnic disparities in surgical care for endometriosis across the United States. Am J Obstet Gynecol 2022;226:824.e1-11.
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