Design: Systematic review.
Setting: N/A
Patients or Participants: Using a search protocol Embase, Medline, Cochrane Library and the grey literature were searched for studies published between 2010-2020. Inclusion criteria were retrospective observational studies that described the association of race/ethnicity with hysterectomy rates, approaches (laparoscopic, abdominal, vaginal), and complication rates. 4990 studies were identified by electronic search, and 80 studies were included in the analysis. Data was extracted by two independent reviewers using a standardized form. Where feasible meta-analysis was performed using RevMan. Quality was assessed by the Newcastle-Ottawa Scale.
Interventions: N/A
Measurements and Main Results: A total of 80 studies were reported from North America (n=75), Europe (n=4), and Asia (n=1). Race/ethnicity was reported for the outcomes of hysterectomy rate (n=51), minimally invasive hysterectomy rate (i.e. Technicity) (n=36), and surgical complications (n=38). Compared with white race/ethnicity, black race/ethnicity was associated with increased hysterectomy rates (n=9) odds ratios (OR) ranged from 1.07 to 1.92, decreased minimally invasive approach (MIA) to hysterectomies (n=16) OR 0.33 to 0.91, and increased surgical complications (n=15) OR 1.12 to 2.76. Compared with white race/ethnicity, Hispanic race/ethnicity was associated with increased hysterectomy rates (n=6) OR 1.17 to 1.38, decreased MIA to hysterectomies (n=10) OR 0.45 to 0.91, and increased surgical complications (n=5) OR 1.25 to 1.99. Compared with white race/ethnicity, Asian/Pacific Islander was associated with increased hysterectomy rates (n=6) OR 1.12 to 2.01, decreased MIA to hysterectomies (n=6) OR 0.65 to 0.92, and increased surgical complications (n=2) OR 1.53 to 2.44. Overall quality of included studies was variable.
Conclusion: Patient race/ethnicity appears to be associated with gynecologic surgical care and outcomes. While these associations may be partly attributable to genetic factors, the concurrent effects of racial disparities and differences in social determinants should also be considered.
Chen, I*1, Sedra, S2, Chang, P2, Kinahan, J2, Le, AL3, Herman, D4, Jackman, V5, Le, T2, Hum, E4. 1Gynecology and Obstetrics, University of Ottawa, Ottawa, ON, Canada; 2The Ottawa Hospital, Ottawa, ON, Canada; 3Ottawa Hospital Research Institute, Ottawa, ON, Canada; 4University of Ottawa, Ottawa, ON, Canada; 5Memorial University of Newfoundland, St. John's, NF, Canada