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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.


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.