Racial Disparities in Minimally Invasive Benign Hysterectomy

Background and objectives: Racial and ethnic disparities in access to minimally invasive surgery (MIS) and the rate of surgical complications in minority groups remain profoundly underinvestigated. This meta-analysis aims to compare the rate of MIS utilization for benign hysterectomy as well as the surgical morbidity among racial and ethnic minority patients in the United States.

Methods: Studies comparing utilization rate of MIS for benign hysterectomy among non-Hispanic white, Black, and Hispanic populations were considered eligible. The primary outcome was the rate of MIS according to race. The secondary outcome was surgical morbidity risk (Clavien-Dindo Classification) according to hysterectomy route and race. Random-effect model meta-analysis pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Thirteen studies were eligible, with a total of 1,123,851 patients undergoing benign hysterectomy, of whom 817,209 were white, 187,488 Black, and 119,154 Hispanic. Black and Hispanic patients were less likely to undergo MIS compared to white patients (Black: OR 0.44 [95% CI 0.39-0.49] and Hispanic: OR 0.65 [95% CI 0.59-0.71]). After pooling adjusted estimates, the rate of MIS use remained significantly lower in nonwhite populations. Nonwhite patients were more likely to develop surgical complications after hysterectomy in either MIS (OR 1.32 [95% CI: 1.15-1.52]) or open hysterectomy (OR 1.56 [95% CI: 1.40-1.73]).

Conclusion: Racial and ethnic disparities in MIS utilization for benign hysterectomy are strikingly apparent in the United States, with nonwhite patients often demonstrating lower access to MIS utilization and higher rates of surgical morbidity than white patients.