Date of Award
Doctor of Philosophy (PhD)
Hundreds of thousands of hysterectomy procedures are performed each year. Because of the open incision and more invasive nature of abdominal hysterectomy, it is associated with increased risk of serious complications, longer hospital stays, hospital readmission, and higher costs. For these reasons, where possible, minimally invasive hysterectomy (vaginal, laparoscopic, robot-assisted) is recommended over abdominal for most benign indications. Nonetheless most hysterectomies are still performed abdominally. Practice patterns of hysterectomy for benign conditions have shifted towards minimally invasive hysterectomy and an ambulatory/outpatient setting. While current research documents this shift in care, how these trends vary by surgical approach and race/ethnicity remains unknown. In addition, it remains unclear whether race/ethnicity is an independent predictor of serious complications and hospital readmission after controlling for confounding factors, including surgical approach, and whether non-White racial groups other than African American race/ethnicity are at increased risk for poorer outcomes in women undergoing hysterectomy for benign conditions. Therefore, this study evaluated whether inpatient and outpatient hysterectomy rates vary by surgical approach and race/ethnicity over time and evidence for racial/ethnic disparity in surgical approach for hysterectomy among women most likely eligible for minimally invasive surgery remains after controlling for patient and hospital characteristics and indications for surgery. In addition, this study evaluated whether medical and surgical complication and hospital readmission rates within 30 and 90 days of hysterectomy for benign conditions differ by race/ethnicity and whether differences in outcomes remain after controlling for patient, hospital, and surgical characteristics. To evaluate these questions, this study used hospital discharge data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery Databases, which contain all inpatient or outpatient/ambulatory billing records from acute-care community hospitals in participating states. Data were analyzed for women 18 years old who underwent hysterectomy for benign conditions. Results revealed that Non-White women, especially African American and Asian Pacific Islander women, are more likely than White women to undergo abdominal hysterectomy and they have higher complication rates. Because minimally invasive surgery is associated with fewer complications than abdominal, it should be performed when feasible, especially in African American women, a population at increased risk of complications. These findings can inform future studies of racial/ethnic disparities in gynecologic surgery and have the potential to influence health policy and hospital practice.
Chair and Committee
Sarah J. Gehlert
Derek Brown, Su-Hsin Chang, Jerry L. Lowder, Timothy McBride,
Pollack, Lisa Marie, "Racial/Ethnic Disparities in Surgical Approach and Postoperative Outcomes Among Patients Undergoing Hysterectomy for Benign Gynecologic Conditions" (2018). Arts & Sciences Electronic Theses and Dissertations. 1645.
Available for download on Monday, August 15, 2118