Racial and ethnic disparities in surgical care for endometriosis across the United States

Megan S. Orlando, Orlando MS, Miguel Luna Russo, Miguel A Luna Russo, Elliott G. Richards, Cara R King, King CR, Amy J. Park, Park AJ, Linda D. Bradley, D.A. Bradley, Bradley LD, Graham C Chapman, Chapman GC, Graham Chapman
American journal of obstetrics and gynecology · 2022 · vol. 226(6) , pp. 824.e1–824.e11 · doi:10.1016/j.ajog.2022.01.021 · PMID:35101410 · W4210593317
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This study examined racial and ethnic disparities in surgical management of endometriosis across the United States, identifying patterns of unequal access and treatment.

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Abstract

BackgroundDespite an estimated 10% prevalence of endometriosis among reproductive-age women, surgical population-based data are limited.ObjectiveWe sought to investigate racial and ethnic disparities in surgical interventions and complications among patients undergoing endometriosis surgery across the United States.Study designWe performed a retrospective cohort study of American College of Surgeons National Surgical Quality Improvement Program data from 2010 to 2018 identifying International Classification of Diseases, Ninth/Tenth Revision codes for endometriosis We compared procedures, surgical routes (laparoscopy vs laparotomy), and 30-day postoperative complications by race and ethnicity.ResultsWe identified 11,936 patients who underwent surgery for endometriosis (65% White, 8.2% Hispanic, 7.3% Black or African American, 6.2% Asian, 1.0% Native Hawaiian or Pacific Islander, 0.6% American Indian or Alaska Native, and 11.5% of unknown race). Perioperative complications occurred in 9.6% of cases. After adjusting for confounders, being Hispanic (adjusted odds ratio, 1.31; 95% confidence interval, 1.06-1.64), Black or African American (adjusted odds ratio, 1.71; confidence interval, 1.39-2.10), Native Hawaiian or Pacific Islander (adjusted odds ratio, 2.08; confidence interval, 1.28-3.37), or American Indian or Alaska Native (adjusted odds ratio, 2.34; confidence interval, 1.32-4.17) was associated with surgical complications. Hysterectomies among Hispanic (adjusted odds ratio, 1.68; confidence interval, 1.38-2.06), Black or African American (adjusted odds ratio, 1.77; confidence interval, 1.43-2.18), Asian (adjusted odds ratio, 1.87; confidence interval, 1.43-2.46), Native Hawaiian or Pacific Islander (adjusted odds ratio, 4.16; confidence interval, 2.14-8.10), and patients of unknown race or ethnicity (adjusted odds ratio, 2.07; confidence interval, 1.75-2.47) were more likely to be open. Being Hispanic (adjusted odds ratio, 1.64; confidence interval, 1.16-2.30) or Black or African American (adjusted odds ratio, 2.64; confidence interval, 1.95-3.58) was also associated with receipt of laparotomy for nonhysterectomy procedures. The likelihood of undergoing oophorectomy was increased for Hispanic and Black women (adjusted odds ratio, 2.57; confidence interval, 1.96-3.37 and adjusted odds ratio, 2.06; confidence interval, 1.51-2.80, respectively), especially at younger ages.ConclusionRace and ethnicity were independently associated with surgical care for endometriosis, with elevated complication rates experienced by Hispanic, Black or African American, Native Hawaiian or Pacific Islander, and American Indian or Alaska Native patients.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Ethnicity Female Hispanic or Latino Humans Retrospective Studies United States United States White People

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