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High-volume Surgeons and Reducing Racial Disparities in Route of Hysterectomy.
Apple, Annie N; Mulugeta-Gordon, Lakeisha; Deagostino-Kelly, Mary; Kinson, Michael S; Farrow, Monique R; Koelper, Nathanael C; Sonalkar, Sarita; James, Abike.
Afiliación
  • Apple AN; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James). Electronic address: annie.apple@pennmedicine.upenn.edu.
  • Mulugeta-Gordon L; Division of Gynecologic Oncology, Abramson Cancer Center at The University of Pennsylvania, Philadelphia, PA (Dr. Mulugeta-Gordon).
  • Deagostino-Kelly M; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James).
  • Kinson MS; Department of Obstetrics and Gynecology, Penn Presbyterian Medical Center, Philadelphia, PA (Drs. Kinson and Farrow).
  • Farrow MR; Department of Obstetrics and Gynecology, Penn Presbyterian Medical Center, Philadelphia, PA (Drs. Kinson and Farrow).
  • Koelper NC; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James).
  • Sonalkar S; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James).
  • James A; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Apple, Deagostino-Kelly, Koelper, Sonalkar, and James).
J Minim Invasive Gynecol ; 2024 Jul 05.
Article en En | MEDLINE | ID: mdl-38972572
ABSTRACT
STUDY

OBJECTIVE:

To examine racial disparities in route of hysterectomy and perioperative outcomes before and after expansion of high-volume minimally invasive surgeons (>10 minimally invasive hysterectomies [MIHs]/year).

DESIGN:

Retrospective cohort study.

SETTING:

Multicenter academic teaching institution. PATIENTS All patients who underwent a scheduled hysterectomy for benign indications during 2018 (preintervention) and 2022 (postintervention).

INTERVENTIONS:

Recruitment of fellowship in minimally invasive gynecologic surgery-trained faculty and increased surgical training for academic specialists in obstetrics and gynecology occurred in 2020. MEASUREMENTS AND MAIN

RESULTS:

Patients in the preintervention cohort (n = 171) were older (median age, 45 years vs 43 years; p = .003) whereas patients in the postintervention cohort (n = 234) had a higher burden of comorbidities (26% American Society of Anesthesiologists class III vs 19%; p = .03). Uterine weight was not significantly different between cohorts (p = .328). Between the pre- and postintervention cohorts, high-volume minimally invasive surgeons increased from 27% (n = 4) to 44% (n = 7) of those performing hysterectomies within the division and percentage of hysterectomies performed via minimally invasive route increased (63% vs 82%; p <.001). In the preintervention cohort, Black patients had a lower percentage of hysterectomies performed via minimally invasive route than White patients (Black = 56% MIH vs White = 76% MIH; p = .014). In the postintervention cohort, differences by race were no longer significant (Black = 78% MIH vs White = 87% MIH; p = .127). There was a significant increase (22%) in MIH for Black patients between cohorts (p <.001). After adjusting for age, body mass index, American Society of Anesthesiologists class, previous surgery, and uterine weight, disparities by race were no longer present in the postintervention cohort. Perioperative outcomes including length of stay (p <.001), infection rates (p = .002), and blood loss (p = .01) improved after intervention.

CONCLUSION:

Increasing fellowship in minimally invasive gynecologic surgery-trained gynecologic surgeons and providing more opportunities in robotic/laparoscopic training for academic specialists may improve access to MIH for Black patients and reduce disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Minim Invasive Gynecol Asunto de la revista: GINECOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Minim Invasive Gynecol Asunto de la revista: GINECOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos