Racial/Ethnic Disparities/Differences in Hysterectomy Route in Women Likely Eligible for Minimally Invasive Surgery

J Minim Invasive Gynecol. Jul-Aug 2020;27(5):1167-1177.e2. doi: 10.1016/j.jmig.2019.09.003. Epub 2019 Sep 10.


Study objective: Evaluate racial/ethnic variation in hysterectomy surgical route in women likely eligible for minimally invasive hysterectomy.

Design: Cross-sectional study.

Setting: Multistate including Colorado, Florida, Maryland, New Jersey, and New York.

Patients: Women aged ≥18 years without diagnoses of leiomyomas, obesity, or previous abdominopelvic surgery who underwent hysterectomy for benign conditions from the State Inpatient and Ambulatory Surgery Databases, 2010-2014.

Interventions: None. Primary exposure is race/ethnicity.

Measurements and main results: Racial/ethnic variation in annual hysterectomy rates and surgical route. To calculate hysterectomy rates per 100 000 women/year, denominators were adjusted for the proportion of women with previous hysterectomy. A marginal structural log binomial regression model was used to estimate adjusted standardized prevalence ratios (aPRs) for vaginal or laparoscopic vs abdominal hysterectomy, controlling for clustering within hospitals. In addition, hospitals were stratified into quintiles to examine surgical route in hospitals that serve a higher vs lower proportion of African American patients. A total of 133 082 adult women underwent hysterectomy for benign conditions from 2010 to 2014. Annual laparoscopic rates increased more slowly for African Americans (1.6-fold) than for whites (1.8-fold) and Hispanics (1.9-fold). African American and Hispanic women were less likely to undergo vaginal (aPR = 0.93; 95% confidence interval [CI], 0.90-0.96 and aPR = 0.95; 95% CI 0.93-0.97, respectively) and laparoscopic hysterectomy (aPR = 0.90; 95% CI, 0.87-0.94 and aPR = 0.95; 95% CI, 0.92-0.98, respectively) than white women; Asian/Pacific Islander women were less likely to undergo vaginal hysterectomy (aPR = 0.88; 95% CI, 0.81-0.96). Hospitals serving a higher proportion of African American persons performed more abdominal and fewer vaginal procedures across all groups, and more racial/ethnic minority women sought care at those hospitals than white women.

Conclusion: African American, Hispanic, and Asian/Pacific Islander women eligible for minimally invasive hysterectomy were more likely than white women to receive abdominal hysterectomy. The proportion of all women undergoing abdominal hysterectomy was highest at hospitals serving higher proportions of African American persons. This difference in treatment type can lead to disparities in outcomes, in part owing to their association with complications.

Keywords: Disparities; Ethnicity; Hysterectomy; Race.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Continental Population Groups / statistics & numerical data*
  • Cross-Sectional Studies
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Healthcare Disparities* / ethnology
  • Healthcare Disparities* / statistics & numerical data
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Hysterectomy / methods*
  • Hysterectomy / statistics & numerical data*
  • Laparoscopy / methods
  • Laparoscopy / statistics & numerical data
  • Middle Aged
  • Minimally Invasive Surgical Procedures / statistics & numerical data*
  • Minority Groups / statistics & numerical data
  • Patient Selection
  • United States / epidemiology