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Access Barriers to Minimally Invasive Hysterectomy

Am J Obstet Gynecol; ePub 2017 Aug 4; Price, et al

The odds of undergoing minimally invasive hysterectomy were diminished in women of Hispanic ethnicity and in those enrolled in Medicaid, but were not discrepant along racial lines, according to a recent cross-sectional study that evaluated factors associated with minimally invasive hysterectomies performed for fibroids and/or abnormal uterine bleeding between 2010 and 2013. Researchers found:

  • Of 1,746 hysterectomies evaluated, 861 (49%) were performed abdominally, 248 (14%) vaginally, 310 (18%) laparoscopically, and 327 (19%) were performed with robot assistance.
  • In univariate analysis, African-American race (OR, 0.80) and Hispanic ethnicity (OR, 0.63) were associated with lower odds of any minimally invasive hysterectomy relative to abdominal hysterectomy.
  • In analyses adjusted for age, body mass index, income quartile, obstetrical and surgical history, uterine weight, and other confounding factors, African-American race was no longer a risk factor for reduced minimally invasive hysterectomy (OR, 0.82).
  • However, Hispanic ethnicity (OR, 0.45) and Medicaid enrollment (OR, 0.59) were associated with significantly lower odds of treatment with any minimally invasive hysterectomy.

Citation:

Price JT, Zimmerman LD, Koelper NC, Sammel MD, Lee S, Butts SF. Social determinants of access to minimally invasive hysterectomy: Re-evaluating the relationship between race and route of hysterectomy for benign disease. [Published online ahead of print August 4, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.07.036.