Department of Obstetrics and Gynaecology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):456-462. doi: 10.1016/j.jmig.2018.05.017. Epub 2018 May 25.
To examine the association between race/ethnicity, route of hysterectomy, and risk of inpatient surgical complications.
Cross-sectional analysis (Canadian Task Force classification III).
Inpatient hospitals in the United States.
There were 114 719 women aged 18 and older from the Nationwide Inpatient Sample who underwent an elective hysterectomy for benign indications using International Classification of Diseases codes.
Multivariable logistic regression was performed to examine the association between race/ethnicity and route of hysterectomy and surgical complications, after adjusting for patient characteristics, clinical factors, and hospital characteristics. Analyses were weighted to provide national estimates of prevalence. The rate of minimally invasive hysterectomy was 55.0% in white women, 28.6% in black women, 50.1% in Hispanic women, and 45.6% in other race/ethnic categories. Compared with white women, black women had a .55 odds (95% confidence interval, .52-.59) of undergoing minimally invasive hysterectomy, after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and diagnosis of myomas. Among women who had an elective hysterectomy, 6091 experienced a complication, representing an estimated 30 455 women nationwide. The rate of surgical complications was 5.3% in white women, 5.9% in black women, 4.6% in Hispanic women, and 5.1% in women of other racial/ethnic groups. There was no difference in odds of experiencing a surgical complication between white and black women (odds ratio, 1.03; 95% confidence interval, .93-1.13) after adjusting for patient, clinical, and hospital characteristics. This finding remained consistent across quartiles of median household income of residence, primary payer, and route of hysterectomy.
Among women undergoing an elective hysterectomy, black women were less likely to receive minimally invasive hysterectomy compared with white women. However, the rate of inpatient surgical complications did not vary significantly by race/ethnicity. Further research is encouraged to identify and address the influential factors behind the disparity in minimally invasive hysterectomy use among black women in the United States.
探讨种族/民族、子宫切除术途径与住院手术并发症风险之间的关系。
横断面分析（加拿大任务组分类 III 级）。
美国住院医院。
从全国住院患者样本中，选择 114719 名年龄在 18 岁及以上的因良性指征接受国际疾病分类代码的择期子宫切除术的女性。
采用多变量逻辑回归分析，在调整患者特征、临床因素和医院特征后，研究种族/民族与子宫切除术途径与手术并发症之间的关系。分析结果进行了加权处理，以提供全国发病率的估计值。白人女性中微创子宫切除术的比例为 55.0%，黑人女性为 28.6%，西班牙裔女性为 50.1%，其他种族/民族为 45.6%。与白人女性相比，黑人女性接受微创子宫切除术的几率为 0.55（95%置信区间，0.52-0.59），调整患者、临床和医院特征后。这一发现在居住地中位数家庭收入、主要支付方和子宫肌瘤诊断的四分位数中保持一致。在接受择期子宫切除术的女性中，有 6091 人发生了并发症，估计全国有 30455 名女性。白人女性的手术并发症发生率为 5.3%，黑人女性为 5.9%，西班牙裔女性为 4.6%，其他种族/民族为 5.1%。调整患者、临床和医院特征后，白人女性和黑人女性发生手术并发症的几率无差异（比值比，1.03；95%置信区间，0.93-1.13）。这一发现在居住地中位数家庭收入、主要支付方和子宫切除术途径的四分位数中保持一致。
在接受择期子宫切除术的女性中，与白人女性相比，黑人女性接受微创子宫切除术的可能性较小。然而，种族/民族之间的住院手术并发症发生率没有显著差异。鼓励进一步研究，以确定并解决美国黑人女性微创子宫切除术使用率差异背后的影响因素。
