Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018

doi:10.1016/j.jmig.2020.02.013

Journal of Minimally Invasive Gynecology

Volume 27, Issue 6, September–October 2020, Pages 1337-1343

https://doi.org/10.1016/j.jmig.2020.02.013 Get rights and content

ABSTRACT

Study Objective

To identify patient and hospital characteristics associated with minimally invasive hysterectomy.

Design

Retrospective population-based analysis of administrative data.

Setting

Data from the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database.

Patients

Women undergoing hysterectomy for benign gynecologic indications in Illinois, 2016 to 2018.

Interventions

None.

Measurements and Main Results

We determined the significance of the proportion of minimally invasive surgery (MIS) versus abdominal hysterectomies by patient and hospital characteristics. Multivariable logistic regression was used to determine the association between patient and hospital characteristics and the likelihood of MIS versus abdominal hysterectomy controlling for the simultaneous effects of all patient and hospital characteristics and year of surgery. There were 42 945 hysterectomies for benign indications at 143 nonfederal Illinois hospitals from 2016 to 2018. More than three-fourths (32 387, 75.4%) of hysterectomies were MIS. Non-Hispanic black patients had the lowest percentage of MIS (54.7%) compared with 82.1% among whites (p <.001). Being non-Hispanic black (odds ratio [OR] = 0.53, 95% confidence interval [CI], 0.47–0.60), other or unknown race and ethnicity (OR 0.76, 95% CI, 0.52–0.85), or having a diagnosis of myomas (OR 0.54, 95% CI, 0.49–0.60) were associated with a lower likelihood of MIS. Patients treated at hospitals with >80% MIS had almost 6 times the likelihood of MIS (OR 5.89, 95% CI, 4.51–7.68).

Conclusion

Black race and a myoma diagnosis were independently associated with decreased odds of undergoing an MIS hysterectomy, whereas the strongest predictor of undergoing an MIS hysterectomy was hospital proportion of minimally invasive procedures.

Section snippets

Data Source and Sample Selection

We performed a retrospective analysis of administrative data using the Illinois Hospital Association Comparative Health Care and Hospital Data Reporting Services Database (COMPdata). The database provides visit-level data for both inpatient and outpatient visits at nonfederal hospitals in Illinois. The International Classification of Diseases, 10th edition, procedure codes were used to capture inpatient hysterectomies, and current procedural technology codes were used to capture outpatient

Results

There were 42 945 hysterectomy procedures for Illinois residents without a gynecologic cancer diagnosis at 143 nonfederal Illinois hospitals from 2016 to 2018. More than three-fourths (32 387, 75.4%) of hysterectomies were performed as MIS. This included 29.6% of all inpatient procedures and virtually all (98.9%) outpatient procedures. The number of hysterectomy procedures overall decreased 6.5% from 14 845 in 2016 to 13 878 in 2018, with the largest decline (17.5%) occurring in abdominal

Discussion

The literature regarding hysterectomy outcomes supports and the American College of Obstetrics and Gynecology encourages the use of MIS whenever feasible [12]. A health disparity can be defined as differences in health or in key determinants of health that adversely affect a particular, often marginalized or underserved group [13]. This study reaffirms the presence of a racial disparity in the route of hysterectomy because non-Hispanic black women in Illinois are half as likely as non-Hispanic

Conclusion

If we define health equity as the attainment of the highest level of health for all people, these findings suggest that there remains a racial disparity in access to MIS hysterectomy [13]. The decision regarding route of surgery is a multifactorial discussion that should take into account patient and provider factors in a shared decision-making format. Whenever possible, minimally invasive approaches should be used, and all patients should have access to surgeons proficient in MIS.

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Surgical approach to hysterectomy for benign gynaecological disease

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Cited by (6)

Each Uterus Counts: A narrative review of health disparities in benign gynaecology and minimal access surgery
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
Zaritsky et al. [32] reported that in a single institution, disparities in MIH access between 2008 and 2015 had been eliminated and that the improvement in MIH access had resulted from the introduction of an integrated healthcare model and an increase in the number of procedures performed by high-volume surgeons. Traylor et al. [27] suggested that regionalisation of care, for instance creating myoma centres could lead to improvement in access to MIH. Conversely, Mehta et al. [18] advocated for local regional training to improve MIH rates in low volume centres.
Health disparities exposed by the Covid-19 pandemic have prompted healthcare professionals to investigate disparities within their own specialty. Racial and ethnic disparities in obstetrics are well documented but inequities in gynaecology are less well known. Our aim is to review the literature on two commonly performed procedures, hysterectomy and myomectomy, and one condition, ectopic pregnancy, to evaluate the prevalence of racial, ethnic and socioeconomic disparities in benign gynaecology and minimal access surgery.
A narrative review of 33 articles identified from a Pubmed using the following search criteria; “race”; “ethnicity”; “socioeconomic status”; “disparity”; “inequity”; and “inequality”. Case reports and papers assessing gynaecological malignancy were excluded.
Despite minimal access surgery having fewer complications and faster recovery than open surgery, US studies have shown that black and ethnic minority women are less likely than white women to have minimally invasive hysterectomies and myomectomies. Uninsured women and patients on Medicaid are also less likely to receive minimally invasive procedures. Contributing factors include fibroid size, geographic location and access to hospitals performing minimal access surgery, and the discontinuation of power morcellation. Ethnic minority women who receive minimally invasive myomectomy have been shown to have a higher risk of complications and prolonged recovery. Black and ethnic minority women also have a higher risk of morbidity and mortality from ectopic pregnancy and are more likely to receive surgical than medical management.
Extensive study from the US has demonstrated disparities in access to minimally invasive gynaecological surgery, whereas in the UK the data is infrequent, inconsistent and incomplete. Little is known about the influence of patient preference and counselling as well as institutional bias on health equity in gynaecology. Further research is necessary to identify interventions that mitigate these disparities in access and outcomes.
Authors’ Reply
2020, Journal of Minimally Invasive Gynecology
Regarding “Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018”
2020, Journal of Minimally Invasive Gynecology
Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications: A Systematic Review
2023, Obstetrics and Gynecology
Disparities in Benign Gynecologic Surgical Care
2023, Clinical Obstetrics and Gynecology
Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology
2021, Current Opinion in Obstetrics and Gynecology

: The authors declare that they have no conflict of interest.

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Original ArticlePatient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018

ABSTRACT

Study Objective

Design

Setting

Patients

Interventions

Measurements and Main Results

Conclusion

Section snippets

Data Source and Sample Selection

Results

Discussion

Conclusion

J Minim Invasive Gynecol

J Minim Invasive Gynecol

J Minim Invasive Gynecol

J Minim Invasive Gynecol

Am J Obstet Gynecol.

J Minim Invasive Gynecol

Womens Health Issues

J Minim Invasive Gynecol

Am J Obstet Gynecol

Surgery

Total laparoscopic hysterectomy: indications, techniques and outcomes

Curr Opin Obstet Gynecol

Surgical approach to hysterectomy for benign gynaecological disease

Cochrane Database Syst Rev

Original Article
Patient and Hospital Characteristics Associated with Minimally Invasive Hysterectomy: Evidence from 143 Illinois Hospitals, 2016 to 2018