Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Curr Opin Obstet Gynecol. 2021 Aug 1;33(4):279-287. doi: 10.1097/GCO.0000000000000719.
To review current US literature and describe the extent, source, and impact of disparities that exist among Black, Indigenous, and people of color (BIPOC) in surgical route and outcomes for hysterectomy, myomectomy, and endometriosis surgery.
Despite the nationwide trend toward minimally invasive surgery (MIS), BIPOC women are disproportionally less likely to undergo MIS hysterectomy and myomectomy and have higher rates of perioperative complications. African American women, in particular, receive significantly disparate care. Contemporary literature on the prevalence of endometriosis in BIPOC women is lacking. Further, there is little data on the racial and ethnic differences in endometriosis surgery access and outcomes.
Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology exist and these differences are not fully accounted for by patient, socioeconomic, or healthcare infrastructure factors. Initiatives that incentivize hiring surgeons trained to perform complex gynecologic surgery, standardized pathways for route of surgery, quality improvement focused on increased hospital MIS volume, and hospital-based public reporting of MIS volume data may be of benefit for minimizing disparities. Further, initiatives to reduce disparities need to address racism, implicit bias, and healthcare structural issues that perpetuate disparities.
综述目的： 回顾美国当前的文献，描述黑人和少数族裔（BIPOC）在接受子宫切除术、子宫肌瘤切除术和子宫内膜异位症手术时手术途径和结局方面存在差异的程度、来源和影响。
最近发现：尽管全国范围内微创手术（MIS）的趋势不断发展，但 BIPOC 女性接受 MIS 子宫切除术和子宫肌瘤切除术的可能性不成比例地较低，且围手术期并发症的发生率更高。非裔美国女性，尤其是，接受的护理存在明显差异。关于 BIPOC 女性中子宫内膜异位症的患病率的当代文献不足。此外，关于子宫内膜异位症手术途径和结局的种族和民族差异的数据很少。
总结：在获得用于良性病理的微创妇科手术方面，存在种族和民族差异，这些差异不能完全归因于患者、社会经济或医疗保健基础设施因素。鼓励招聘接受过复杂妇科手术培训的外科医生、标准化手术途径、以增加医院 MIS 量为重点的质量改进以及基于医院的 MIS 量数据的公开报告等举措可能有助于最大限度地减少差异。此外，减少差异的举措需要解决导致差异持续存在的种族主义、隐性偏见和医疗保健结构性问题。
