Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California (Ms. Ko); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut (Ms. Ko).
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut (Drs. Suh and Harmanli).
J Minim Invasive Gynecol. 2021 Jul;28(7):1403-1410.e2. doi: 10.1016/j.jmig.2020.11.008. Epub 2020 Nov 23.
To evaluate the associations among race/ethnicity, route of surgery, and perioperative outcomes for women undergoing hysterectomy for uterine leiomyomas.
Retrospective cohort study.
Multistate.
Women who underwent hysterectomies for leiomyomas from the American College of Surgeons National Surgical Quality Improvement Program database, 2014 to 2017.
None. Exposures of interest were race/ethnicity and route of surgery.
Racial/ethnic variation in route of surgery and perioperative outcomes. Propensity score matching was employed to control for possible confounders. We identified 20 133 women who underwent nonemergent abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) for leiomyomas. We defined minimally invasive hysterectomy (MIH) as LH or VH. Black women were more likely to have open surgery (AH vs MIH adjusted odds ratio [aOR], 2.22; 95% confidence interval [CI], 2.07-2.38; AH vs VH aOR, 1.79; 95% CI, 1.54-2.08; AH vs LH aOR, 2.27; 95% CI, 2.13-2.44) than white women. Likewise, Hispanic women were more likely to have open surgery (AH vs MIH aOR, 1.76; 95% CI, 1.58-1.96; AH vs LH aOR, 1.82; 95% CI, 1.61-2.00) than white women. Black women were more likely to experience any complication after hysterectomy (AH aOR, 1.54; 95% CI, 1.31-1.80; VH aOR, 1.65; 95% CI, 1.02-2.68; LH aOR, 1.37; 95% CI, 1.13-1.66) than white women. Hispanic women were less likely than white women to experience major complications after VH (aOR, 0.28; 95% CI, 0.08-0.98). Compared with white women, the mean length of stay was longer for black women who underwent AH or LH. The mean total operation time was higher for all minority groups (except for Asian/other undergoing AH) regardless of surgical approach.
Women of minority race/ethnicity were more likely to undergo abdominal rather than MIH for leiomyomas. Even when controlling for route of surgery, they were more likely to experience perioperative complications.
评估种族/民族、手术途径与女性子宫肌瘤子宫切除术围手术期结局的关系。
回顾性队列研究。
多州。
2014 年至 2017 年，美国外科医师学会国家外科质量改进计划数据库中因子宫肌瘤接受子宫切除术的女性。
无。感兴趣的暴露因素为种族/民族和手术途径。
手术途径和围手术期结局的种族/民族差异。采用倾向评分匹配来控制可能的混杂因素。我们确定了 20133 名因子宫肌瘤接受非紧急经腹子宫切除术（AH）、腹腔镜子宫切除术（LH）或阴道子宫切除术（VH）的女性。我们将微创子宫切除术（LH 或 VH）定义为 MIH。黑人女性更有可能接受开放性手术（与白人女性相比，AH 与 MIH 调整后的优势比 [aOR]，2.22；95%置信区间 [CI]，2.07-2.38；AH 与 VH 的 aOR，1.79；95%CI，1.54-2.08；AH 与 LH 的 aOR，2.27；95%CI，2.13-2.44）。同样，西班牙裔女性更有可能接受开放性手术（与白人女性相比，AH 与 MIH 的 aOR，1.76；95%CI，1.58-1.96；AH 与 LH 的 aOR，1.82；95%CI，1.61-2.00）。黑人女性在接受子宫切除术（AH 的 aOR，1.54；95%CI，1.31-1.80；VH 的 aOR，1.65；95%CI，1.02-2.68；LH 的 aOR，1.37；95%CI，1.13-1.66）后发生任何并发症的可能性高于白人女性。与白人女性相比，西班牙裔女性在 VH 后发生主要并发症的可能性低于白人女性（aOR，0.28；95%CI，0.08-0.98）。与白人女性相比，接受 AH 或 LH 的黑人女性的平均住院时间较长。无论手术途径如何，所有少数群体（接受 AH 的亚裔/其他族裔除外）的总手术时间均较高。
少数族裔女性更有可能因子宫肌瘤而接受腹部手术，而非微创子宫切除术。即使控制了手术途径，她们也更有可能经历围手术期并发症。
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