This is the first study to document racial and socioeconomic disparities in access to minimally invasive hysterectomy (MIH) at a large urban academic hospital and to propose stakeholder-invested interventions to address identified disparities.
Design:
Retrospective cohort study.
Setting:
Large academic hospital.
Patients or Participants:
The study included 4,663 women who underwent hysterectomy for benign indications between 2009 and 2022. Vaginal hysterectomies and those performed for the indication of prolapse or by Urogynecologists or Gynecologic Oncologists were excluded from analysis.
Interventions:
Following the identification of disparities, a series of stakeholder meetings involving gynecologic surgeons and quality, safety, and equity experts were convened where we reviewed potential interventions to address disparities and improve equitable access to care.
Measurements and Main Results:
Disparities in access to MIH were observed, with Black patients having lower odds of undergoing MIH compared to White patients in an analysis adjusting for potential confounders, including uterine weight and prior surgeries. However, these differences were no longer significant after adjusting for the social vulnerability index (SVI) and insurance type. Within the Minimally Invasive Gynecologic Surgery (MIGS) division, racial disparities were not observed. Proposed interventions aimed to improve education for both clinicians and patients, enhance counseling regarding minimally invasive options, establish a surgical review committee, and optimize workforce utilization.
Conclusion:
This study identified disparities in access to MIH at BWH and suggests that the role of systemic factors plays a central role in perpetuating racial inequities. By implementing targeted interventions we aim to improve access to MIH for all patients. This collaborative effort represents a model for addressing disparities in gynecologic surgery and underscores the importance of systemic change in achieving equitable healthcare delivery. Future work will assess the effectiveness of these interventions and explore access to other minimally invasive gynecologic procedures such as myomectomy.