Racial Disparities in Hysterectomy Route for Benign Disease: Examining trends and perioperative complications from 2007-2018 using the NSQIP database

Study Objective

To examine national trends among race and ethnicity and route of benign hysterectomy
from 2007-2018.

Design

This is a retrospective analysis of the prospective National Surgical Quality Improvement
Program (NSQIP) cohort program.

Setting

This study included data from the NSQIP database including data from the 2014-2018
targeted hysterectomy files.

Patients

Adult patients undergoing hysterectomy.

Interventions

None

Measurements and Main Results

Current Procedural Terminology codes identified women undergoing benign hysterectomy
and perioperative data including race and ethnicity were obtained. To determine relative
trends in hysterectomy among race and ethnicity cohorts (White, Black, Hispanic),
we calculated the proportion of each procedure performed annually within each race
and ethnicity group and compared it across groups. From 2007 to 2018, 269,794 hysterectomies
were collected (190,154 White, 45,756 Black, and 33,884 Hispanic). From 2007 to 2018,
rates of laparoscopic hysterectomy increased in all cohorts (30.2% to 71.6% for White,
23.9% to 58.5% for Black, 19.9% to 64.0% for Hispanic; p_trend<0.01 for all). For each year from 2007-2018 the proportion of women undergoing open
abdominal hysterectomy remained twice as high in Black Women compared to White women
(33.1% to 14.4%, p<0.01). Data from the 2014-2018 targeted files showed Black and
Hispanic women undergoing benign hysterectomy were generally younger, had larger uteri,
were more likely to be current smokers, have diabetes and/or hypertension, have higher
BMI, and have undergone prior pelvic surgery; (p≤0.01 for all).

Conclusion

As compared to White women, Black and Hispanic women are less likely to undergo benign
hysterectomy via a minimally invasive approach. While larger uteri and comorbid conditions
may attribute to higher rates of open abdominal hysterectomy, the higher prevalence
of abdominal hysterectomy among younger Black and Hispanic women highlights potential
racial disparities in women’s health and access to care.