A National Database Study on Racial Disparities in Route of Hysterectomy With a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications

Abstract

Study Objective

To investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding (AUB) in the absence of uterine myoma disease and excluding malignancy.

Design

A cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive routes of hysterectomy.

Setting

Hospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019.

Patients

A total of 75 838 patients who had undergone hysterectomy for AUB, excluding uterine myoma and malignancy.

Interventions

n/a

Measurements and Main Results

Of the 75 838 hysterectomies performed for AUB in the absence of uterine myomas and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12–1.70 p = .002). Black race, thus, is independently associated with open surgery.

Conclusion

Despite excluding uterine myomas as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy, and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.