Design: Retrospective cohort study

Setting: In 2021, a MIGS fellowship was developed, spurring the creation of a specialty clinic for complex gynecologic conditions, which served a higher proportion of government-insured, Black, and Hispanic patients, who are historically more likely to receive open abdominal approaches than their white counterparts.

Patients or Participants: Patients undergoing hysterectomy for benign indications between 2017 to 2023 within a single academic hospital system

Interventions: Patients were split into two groups: Those with surgery occuring before the fellowship initiation (January 2020 to August 2021) or after (September 2021 to January 2023). Additional data was collected regarding their pre-operative care site, either a private clinic or the aforementioned specialty clinic.

Measurements and Main Results: A total of 494 patients met inclusion criteria; 181 (37%) prior to the initiation of the MIGS fellowship program, and 313 (63%) after initiation. Groups did not significantly differ in age (p=0.052), race (p=0.5), BMI (p>0.9) or parity (p =0.3). Hysterectomy rates significantly increased in government-insured patients after the fellowship initiation, with 78% of patients undergoing MIS hysterectomy after (n=245) compared to 65% prior (n=118) (p<0.001). After implementation of the MIGS fellowship, there was a significantly higher proportion of hysterectomies for larger weight (>250g) uteri (26% vs 38%, p<0.007). While not significant, there was a trend towards patients with larger uteri undergoing MIS rather than abdominal hysterectomy (67% vs 54%, p = 0.013). This is a promising trend for a newly established fellowship.

Conclusion: The creation of a MIGS fellowship within the safety-net community healthcare system showed significant improvements in hysterectomy rates for government-insured patients, particularly for larger weight uteri. The creation of the fellowship resulted in institution-wide impacts, increasing equity in access for low income and minority patients.