Design: A retrospective study using the National Inpatient Sample Database (NIS) from 2009-13 comparing procedures, surgical routes, and postoperative complications by race/ethnicity, income, and payer.
Setting: the United States
Patients or Participants: Amongst females (ages 7-65) diagnosed with endometriosis or CPP (n=125,213).
Interventions: Analyzed surgery outcomes by race, income(Q), and payer with surgical outcomes using multivariable logistic regression models. Adjusted odds ratios (aOR) were calculated with White, high median-income, or Medicaid-payer patients as the reference groups.
Measurements and Main Results: Adjusting for confounders, Black (aOR 1.48 [1.30, 1.68]), Hispanic (aOR 1.35 [1.18, 1.54]), and Asian (aOR 2.84 [2.30, 3.50]) patients, those with private insurance (aOR 1.68 [1.49, 1.89]), self-pay (aOR 1.71 [1.41, 2.07]), or other payers (aOR 1.82 [1.49, 2.22]), were more likely to have a laparotomy, but less likely for lower income patients (aOR 0.77 [0.67, 0.88]). Black (aOR 0.41[0.37, 0.45], Hispanic (aOR 0.59 [0.52, 0.67]), and Asian (aOR 0.31[0.26, 0.38]) patients and those with private insurance (aOR 0.73 [0.67, 0.81]) or self-pay (aOR 0.43 [0.37, 0.51]) were less likely to have a hysterectomy. Black (aOR 0.57 [0.51, 0.63]) and Hispanic (aOR 0.77 [0.69, 0.86]) patients were less likely to have an oophorectomy. Asian (aOR 1.57 [1.26, 1.96]) patients and those with private insurance (aOR 1.62 (1.41, 1.87)) were more likely to have an ablation/excision of endometriosis, but those with a lower income (Q1 aOR 0.70 [0.60, 0.81]) were less likely. Black patients (aOR 1.48 [1.15, 1.91]) were more likely to have complications.
Conclusion: In the United States, race, income, and payer are associated with the type of surgical care received in patients with endometriosis and CPP. Complications are significantly higher in Black patients. Supported by NIH NICHD P01 HD 106414.
Okorie, CN*1, Meghan, A2, Bejerano, S2, Rodriguez, A3, Sirota, M4, Oskotsky, T5, Giudice, L6, Opoku-Anane, J2. 1Department of Obstetrics, Gynecology & Reproductive Sciences,, University of California, San Francisco, San Francisco, CA; 2Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University, New York, NY; 3St. George's University-School of Medicine, University Centre Grenada, West Indies, Grenada; 4Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA; 5School of Medicine, University of California, San Francisco, San Francisco, CA; 6Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA