Association of Race/Ethnicity with Surgical Route and Perioperative Outcomes of Hysterectomy for Leiomyomas

Abstract

To evaluate the associations among race/ethnicity, route of surgery, and perioperative outcomes for women undergoing hysterectomy for uterine leiomyomas. Design: Retrospective cohort study. Setting: Multistate. Patients: Women who underwent hysterectomies for leiomyomas from the American College of Surgeons National Surgical Quality Improvement Program database, 2014 to 2017. Interventions: None. Exposures of interest were race/ethnicity and route of surgery. Measurements and Main Results: Racial/ethnic variation in route of surgery and perioperative outcomes. Propensity score matching was employed to control for possible confounders. We identified 20 133 women who underwent nonemergent abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) for leiomyomas. We defined minimally invasive hysterectomy (MIH) as LH or VH. Black women were more likely to have open surgery (AH vs MIH adjusted odds ratio [aOR], 2.22; 95% confidence interval [CI], 2.07−2.38; AH vs VH aOR, 1.79; 95% CI, 1.54−2.08; AH vs LH aOR, 2.27; 95% CI, 2.13−2.44) than white women. Likewise, Hispanic women were more likely to have open surgery (AH vs MIH aOR, 1.76; 95% CI, 1.58−1.96; AH vs LH aOR, 1.82; 95% CI, 1.61−2.00) than white women. Black women were more likely to experience any complication after hysterectomy (AH aOR, 1.54; 95% CI, 1.31−1.80; VH aOR, 1.65; 95% CI, 1.02−2.68; LH aOR, 1.37; 95% CI, 1.13−1.66) than white women. Hispanic women were less likely than white women to experience major complications after VH (aOR, 0.28; 95% CI, 0.08−0.98). Compared with white women, the mean length of stay was longer for black women who underwent AH or LH. The mean total operation time was higher for all minority groups (except for Asian/other undergoing AH) regardless of surgical approach. Conclusion: Women of minority race/ethnicity were more likely to undergo abdominal rather than MIH for leiomyomas. Even when controlling for route of surgery, they were more likely to experience perioperative complications.

Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature

“…Of these, 81 studies were subsequently excluded after the examination of the abstract and full text: 29 manuscripts were excluded because only the abstract was retrieved, 24 as they did not have English language and 28 because they did not have an adequate population and intervention. Definitively, 38 articles were included in our systematic review ( Figure 1 ) [ 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Data synthesis was available in Table 1 and Table 2 .…”

“…The most common therapy for cervical leiomyomas is represented by surgery; however, compared to myomas of the uterine corpus, which are treated with conservative myomectomy [ 10 , 11 ] or hysterectomy [ 12 ], the surgical treatment of cervical leiomyomas can be more difficult; this is due to the risk of intraoperative hemorrhage and to the potential injuries to the adjacent organs that are often dislocated and contiguous to the cervical leiomyoma; this may cause a subverted anatomy of the pelvis requiring experienced surgeons [ 13 ]; furthermore, the position of the leiomyoma in the cervix poses an extra challenge in the surgical approach in case of a fertility-sparing approach. Currently, a standard surgical treatment for the leiomyomas of the cervix still lacks; therefore, the therapeutic approach depends on the characteristics of the patient, the desire for fertility and the experience of the individual centers and surgeons [ 14 ].…”

Disparities in Benign Gynecologic Surgical Care

“…When considering patient demographics, Black and other minorities have poorer surgical outcomes and undergo fewer minimally invasive surgical procedures. 3 Researchers have hypothesized that the discrepancy in fibroids, uterus size, socioeconomic status, medical comorbidities, and medical access may explain the disparity in MIHs. 3 However, recent studies have revealed that even when accounting for these factors, Black women experience more postoperative complications.…”

“…3 Researchers have hypothesized that the discrepancy in fibroids, uterus size, socioeconomic status, medical comorbidities, and medical access may explain the disparity in MIHs. 3 However, recent studies have revealed that even when accounting for these factors, Black women experience more postoperative complications. Ko and colleagues, in a study of 20,133 women undergoing hysterectomy, described significant differences in surgical route by race.…”

“…19 Perioperative outcomes and complications are those that occur during surgery (ie, blood transfusion and injury to surrounding structures), as well as those that occur postoperatively (ie, transfers to intensive care unit, unplanned reoperations, surgical site infections, and deep venous thrombosis/pulmonary embolism). Ko et al 3 discovered that of 20,133 women who underwent hysterectomy for fibroids in the American College of Surgeons National Surgical Quality Improvement Database (NSQIP), Black patients were more likely to experience postoperative complications than White patients, across surgical routes: AH (aOR = 1.54; 95% CI, 1.31-1.80); VH (aOR = 1.65; 95% CI, 1.02-2.68); LH (aOR = 1.37; 95% CI, 1.13-1.66). In addition, Black women were more likely to have a prolonged hospital stay compared with White women for both AH and LH (2.6 vs. 2.3 d and 1.1 vs. 0.9 d, respectively).…”