This study aims to investigate disparities in minimally invasive hysterectomy (MIH) based on geographic location among a diverse population in Florida.
Design:
A cross-sectional analysis was conducted using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Ambulatory Surgery Databases (SASD) from Florida for the year 2019.
Setting:
The study utilized data from all-payer population-based databases capturing inpatient hospital discharge abstracts and encounters for ambulatory surgery and outpatient services from hospital-owned facilities in Florida.
Patients or Participants:
Patients aged 18 or older who underwent hysterectomy for benign indications were included in the study. Patients with a diagnosis of gynecologic cancer and those with missing data on urban-rural classification were excluded.
Interventions:
The primary exposure of interest was living in a rural county based on population density thresholds less than 50,000. The primary outcome was the type of hysterectomy, comparing abdominal with minimally invasive procedures.
Measurements and Main Results:
Among the 34,228 patients included, there was no significant difference in the distribution of surgery types between rural and urban residents. Age, race/ethnicity, primary payer type, obesity, and indication for hysterectomy were significantly associated with the type of surgery received. Racial disparities were observed, with Black patients, Hispanic patients, and patients from other racial backgrounds having lower odds of receiving MIS compared to White patients.
Conclusion:
While geographic area did not significantly influence the type of surgery received, demographic, clinical, and insurance-related factors played significant roles. Efforts to address disparities in access to minimally invasive gynecologic surgery should consider the interplay of various factors influencing surgical decision-making, aiming for equitable access across diverse patient populations.
Overall, the study underscores the importance of ensuring equitable access to minimally invasive gynecologic surgery and future work could further investigate the role that geographic location plays in access to care.