Racial disparities in surgical care for uterine XXXX .

@entity1 @entity5 @entity1488
OBJECTIVE: To evaluate the association of race and surgical approach for @entity1 who underwent surgical treatment for uterine @entity5 . METHODS: The design was a retrospective cohort study of discharge data from nonfederal acute care hospitals in Maryland from 2000 to 2009. @entity1 aged 18 and older who underwent hysterectomy for uterine @entity5 were included in the study population. The main outcome measure was receipt of lymphadenectomy. Secondary outcomes included receipt of minimally-invasive surgical approach, in-hospital mortality and individual surgeon and individual hospital annual uterine @entity5 case volume. The independent variable was race. We used logistic regression to calculate odds ratios and confidence intervals for each outcome of interest. Caucasians were the reference group. RESULTS: Among 5470 @entity1 who underwent hysterectomy, 2727 (49.9%) underwent lymphadenectomy and 512 (9.4%) underwent surgery through a minimally-invasive approach. After adjusting for age, payer status and @entity1488 -DRG mortality risk score, African-Americans were more likely to be operated on by high-volume surgeons (adjusted OR=1.27, 95% CI: 1.09-1.49) yet were less likely to undergo minimally-invasive surgery (adjusted OR=0.60, 95% CI: 0.45-0.80). For the outcome of lymphadenectomy, there was no significant difference between Caucasians and African-Americans (OR=1.13, 95% CI: 0.98-1.30). There was no association between race and in-hospital mortality or between race and the odds of undergoing surgery at a high-volume hospital. CONCLUSION: In this retrospective analysis of uterine @entity5 @entity1 , race is associated with likelihood of undergoing surgery through a minimally-invasive approach. Further analysis using prospectively collected data with more detail regarding peri-operative parameters is needed to further clarify possible reasons for this disparity.
