Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology

Abstract

Purpose of review To review current US literature and describe the extent, source, and impact of disparities that exist among Black, Indigenous, and people of color (BIPOC) in surgical route and outcomes for hysterectomy, myomectomy, and endometriosis surgery. Recent findings Despite the nationwide trend toward minimally invasive surgery (MIS), BIPOC women are disproportionally less likely to undergo MIS hysterectomy and myomectomy and have higher rates of perioperative complications. African American women, in particular, receive significantly disparate care. Contemporary literature on the prevalence of endometriosis in BIPOC women is lacking. Further, there is little data on the racial and ethnic differences in endometriosis surgery access and outcomes. Summary Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology exist and these differences are not fully accounted for by patient, socioeconomic, or healthcare infrastructure factors. Initiatives that incentivize hiring surgeons trained to perform complex gynecologic surgery, standardized pathways for route of surgery, quality improvement focused on increased hospital MIS volume, and hospital-based public reporting of MIS volume data may be of benefit for minimizing disparities. Further, initiatives to reduce disparities need to address racism, implicit bias, and healthcare structural issues that perpetuate disparities.

Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities

“…For instance, higher rates of individual and community level poverty as well as the physiological impact of racism and discrimination on racial and ethnic minorities are associated with worse overall health status and access to health care as well as higher social needs and financial barriers affecting the ability to access health care 28,30–32 . This in turn contributes to more comorbidities and decreased functional status at the time of surgical diagnosis, delayed presentations and lower access to preventative, surveillance, or follow-up services for surgical diagnoses 33–36 …”

“…28,[30][31][32] This in turn contributes to more comorbidities and decreased functional status at the time of surgical diagnosis, delayed presentations and lower access to preventative, surveillance, or follow-up services for surgical diagnoses. [33][34][35][36] At the provider level, inequities in education and economic mobility among racial and ethnic groups create barriers (ie, financial costs of applying and attending medical school, concentration in low performing middle and high schools, and lack of mentorship in higher education, etc.) to entry into the health care workforce as surgeons or health care systems leaders.…”

Dobbs and disability: Implications of abortion restrictions for people with chronic health conditions

“… 35 Black women diagnosed with endometriosis are less likely to have minimally invasive gynecological surgery. 36 Black and Hispanic women are less likely to receive guideline‐concordant care for gynecologic and breast cancers. 37 Even after accounting for differences in overall health, severity of disease, access to care, and other related factors, racial inequities in diagnosis and treatment remain.…”

“…For example, Black patients with diabetes are less likely to be prescribed the highest quality diabetes medication 35 . Black women diagnosed with endometriosis are less likely to have minimally invasive gynecological surgery 36 . Black and Hispanic women are less likely to receive guideline‐concordant care for gynecologic and breast cancers 37 .…”

FIGO statement: Disparities in patients' access to benign gynecological surgery

“…This disparity is more marked for LMICs. When it comes to accessing surgical procedures, the gap is even greater [9–11].…”