Impact of Race and Ethnicity on Perioperative Outcomes During Hysterectomy for Endometriosis.

Study Objective

: Assess whether complications incurred during hysterectomy for the treatment of endometriosis
differ among racial-ethnic groups.

Design

: Retrospective cohort study.

Setting

: American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
database from 2014-2019. The NSQIP database is a robust, comprehensive, multi-institutional
database with nearly 700 participating hospitals.

Patients

: Patients with a diagnosis of endometriosis or with an endometriosis associated symptom
as the primary indication for surgery and surgical intraoperative documentation of
endometriosis.

Interventions

: Compare perioperative complications by patient race and ethnicity.

Measurements and Main Results

: 5,639 patients underwent hysterectomy for endometriosis; 4368 White patients (77.5%),
528 Black patients (9.4%), 491 Hispanic patients (8.7%), 252 Asian patients (4.5%).
There was no association between location of endometriosis and patient race and ethnicity.
However, White patients had highest rate and Asian patients had the lowest rate of
laparoscopic hysterectomy, 85.3% vs 69.8% respectively (p<0.01). Additionally, there
were differences in concomitant procedures performed at time of hysterectomy based
on race and ethnicity with White patients having the highest rates of adnexal/peritoneal
surgery at 12.5% (p<0.01) compared to patients of the other racial and ethnic groups.
Asian patients had the highest rate of ureteral surgery at 6.8% (p<0.01) and highest
rate of intestinal surgery at 16.3% (p<0.01) compared to patients of the other racial
and ethnic groups. There was no association between rates of concomitant bladder surgery,
appendectomy or rectal surgery based on patient race and ethnicity. Black patients
had the highest rate of minor complications at 13.5% (p<0.01) and the highest rate
of major complications at 6.6% (p<0.01) compared to patients of the other racial and
ethnic groups. After multivariable analysis, Black patients still had increased odds
of having a major complication compared to patients of the other racial and ethnic
groups even after controlling for patient characteristics and perioperative factors
such as endometriosis lesion location, surgical approach, and concomitant procedures
(OR 1.64, 95% CI 1.10-2.45).

Conclusion

: Endometriosis lesion location did not differ based on patient race and ethnicity.
However, patient race and ethnicity did have an impact on the surgical approach and
the concomitant surgical procedures performed at time of hysterectomy. Black patients
had the highest odds of major complications.