INTRODUCTION: Minimally invasive gynecologic surgery (MIGS) has revolutionized the surgical management of benign gynecologic disease by reducing morbidity, decreasing hospital stays, and promoting faster recovery. Despite these advances, racial and socioeconomic disparities persist in both access to and outcomes from these procedures, particularly among Black women. Prior studies demonstrate that Black women are more likely to undergo abdominal hysterectomy, which is associated with longer recovery times and higher complication rates, compared with White women. At our institution which serves a predominantly Black population, we sought to investigate if establishment of a robust MIGS division has resulted in improved surgical outcomes and decreased disparity within our patient population. OBJECTIVE: To compare postoperative complication rates after hysterectomy and myomectomy by race and socioeconomic status, while accounting for route of surgery, uterine size, and surgical indication. METHODS: Data were obtained from a curated surgical database and verified through retrospective chart review of patients who underwent laparoscopic or abdominal hysterectomy or myomectomy at a single tertiary academic institution between 2020 and 2023. Patients with non-benign indications for hysterectomy or who underwent hysteroscopic myomectomy alone were excluded. The primary outcome was the occurrence of ≥1 postoperative complication, classified as major or minor. RESULTS: Of 915 patients who met inclusion criteria, the overall rate of any postoperative complication was 5.2%. Black patients (n=526, 57%) had larger uteri or fibroids (mean specimen weight 225.8 g vs 98.2 g for White patients) and were less likely to undergo minimally invasive surgery (MIS) (72.0% vs 98.1% for White patients, n=267). However, after adjustment for specimen weight, complication rates did not differ significantly between Black (3.8%) and White patients (1.2%, p=0.08). By insurance type, 149 patients had public insurance and 720 had private insurance. Patients with public insurance were more likely to undergo MIS (85.8% vs 76.6%, p=0.009), although complication rates were not significantly different (10.0% vs 8.5%, p=0.55). CONCLUSIONS: At our tertiary care academic institution with a strong minimally invasive gynecologic practice, a high proportion of hysterectomies and myomectomies were performed via minimally invasive approach. There was no statistically significant difference in postoperative complication rate by Black vs White race, or by public vs private insurance. These data further support possible benefits of investing in MIGS trained physicians for institutions which serve higher proportions of Black or publicly insured patients as a potential solution to help address disparities in gynecologic surgery outcomes.Table 1
Asdell et al. (Fri,) studied this question.