Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead (Drs. Fakas, Lu, Blitz, and Rodriguez-Ayala).
Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York (Ms. Shahani and Dr. Blitz).
J Minim Invasive Gynecol. 2022 Sep;29(9):1104-1109. doi: 10.1016/j.jmig.2022.06.003. Epub 2022 Jun 9.
To determine whether surgical management of abnormal uterine bleeding (AUB) is associated with social vulnerability index (SVI).
A retrospective cohort.
A total of 7 hospitals and 4 ambulatory surgery centers within a large New York health system.
All patients between 15 and 45 years of age who underwent either a hysterectomy or myomectomy for AUB between January 2019 and October 2021.
None. Home addresses were linked to census tracts and SVI scores. SVI is composed of 4 themes that potentially influence a community's vulnerability to health stressors: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Multiple logistic regression analyses were performed to evaluate the association between SVI and surgical procedure/approach, adjusting for age, race and ethnicity, marital status, insurance, language, body mass index, and previous abdominal surgery.
A total of 1628 patients were included. On performing regression analysis between SVI quarters and type of surgery, the odds of undergoing laparotomy for the hysterectomy group were not affected by SVI composite score both before and after adjusting for alternative factors (odds ratio [OR] and adjusted OR). Among those who had a myomectomy, individuals in SVI Q3 had 1.86 times (95% confidence interval, 1.27-2.72) higher odds of having a laparotomy than those in SVI Q1. Individuals in SVI Q4 had 1.74 times (95% confidence interval, 1.15-2.62) higher odds of having a laparotomy than those in SVI Q1. Although some unadjusted ORs were statistically significant in the myomectomy group, when adjusted for social, demographic, and economic factors, the results were not statistically significant.
Patients living in more vulnerable communities are less likely to have minimally invasive hysterectomy or myomectomy for the management of AUB. Neighborhood characteristics are independently associated with surgical procedure and approach.
确定异常子宫出血（AUB）的手术治疗是否与社会脆弱性指数（SVI）相关。
回顾性队列研究。
一家大型纽约健康系统内的 7 家医院和 4 家日间手术中心。
2019 年 1 月至 2021 年 10 月期间因 AUB 接受子宫切除术或子宫肌瘤切除术的 15 至 45 岁之间的所有患者。
无。家庭住址与普查区和 SVI 得分相关联。SVI 由 4 个主题组成，这些主题可能影响社区对健康压力的脆弱性：社会经济地位、家庭构成和残疾、少数民族地位和语言、住房类型和交通。进行多变量逻辑回归分析，以评估 SVI 与手术程序/方法之间的关联，调整年龄、种族和民族、婚姻状况、保险、语言、体重指数和先前的腹部手术。
共纳入 1628 例患者。在对 SVI 季度和手术类型之间进行回归分析时，子宫切除术组接受剖腹手术的几率不受 SVI 综合评分的影响，无论是在调整替代因素之前还是之后（比值比[OR]和调整后的 OR）。在接受子宫肌瘤切除术的患者中，SVI Q3 患者的剖腹手术几率是 SVI Q1 患者的 1.86 倍（95%置信区间，1.27-2.72）。SVI Q4 患者的剖腹手术几率是 SVI Q1 患者的 1.74 倍（95%置信区间，1.15-2.62）。虽然在子宫肌瘤切除术组中，一些未调整的 OR 具有统计学意义，但在调整社会、人口和经济因素后，结果没有统计学意义。
生活在更脆弱社区的患者不太可能接受微创子宫切除术或子宫肌瘤切除术来治疗 AUB。社区特征与手术程序和方法独立相关。
