Mode of Hysterectomy in the Veterans Administration: Associations With Race/Ethnicity and Clinical Factors [2H]

INTRODUCTION: Evidence from the general population suggests that factors such as race/ethnicity and socioeconomic status, in addition to clinical factors, may influence hysterectomy route. We investigated factors associated with mode of hysterectomy in the Veterans Administration (VA). METHODS: We conducted a retrospective cohort study using VA data from 2008-2014 to identify women undergoing hysterectomy for benign indications. The outcome was hysterectomy mode [laparoscopic (total laparoscopic, laparoscopic-assisted vaginal, and robotic), vaginal, or abdominal], classified by ICD-9 codes. We used modified Poisson regression to estimate associations of demographic and clinic factors with hysterectomy mode including age, race/ethnicity, income, body mass index (BMI), indication (fibroids, endometriosis, prolapse), medical and mental health conditions, and where the procedure was performed (VA versus non-VA facility). RESULTS: Among 7844 identified hysterectomies, 58% were abdominal, 25% laparoscopic, and 17% vaginal. In adjusted models, compared to Whites, Blacks had 36% lower risk of having a laparoscopic versus abdominal hysterectomy (RR:0.64, 95%CI 0.16-0.51) and 44% lower risk of having vaginal versus abdominal hysterectomy (RR:0.56, 95%CI 0.28-0.56). Hispanics were equally likely to have laparoscopic versus abdominal hysterectomy compared to Whites, but had lower risk of vaginal versus abdominal hysterectomy (RR:0.62, 95%CI 0.10-0.58). Women with fibroids and BMI >30 were less likely to undergo laparoscopic or vaginal versus abdominal hysterectomy, whereas women with endometriosis were more likely to undergo laparoscopic versus abdominal hysterectomy. CONCLUSION: In addition to indication for surgery and BMI, race/ethnicity is independently associated with benign hysterectomy mode in VA. Further study is needed to explore the underlying causes of this apparent disparity.