• Anju Ranjit, Meesha Sharma, Aasia Romano, Wei Jiang, Bart Staat, Tracey Koehlmoos, Adil H Haider, Sarah E Little, Catherine T Witkop, Julian N Robinson, and Sarah L Cohen.
• Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts. Electronic address: aranjit@bwh.harvard.edu.
• J Minim Invasive Gynecol. 2017 Jul 1; 24 (5): 790-796.

Study ObjectiveTo determine if racial differences exist in receipt of minimally invasive hysterectomy (defined as total vaginal hysterectomy [TVH] and total laparoscopic hysterectomy [TLH]) compared with an open approach (total abdominal hysterectomy [TAH]) within a universally insured patient population.DesignRetrospective data analysis (Canadian Task Force classification II-2).SettingThe 2006-2010 national TRICARE (universal insurance coverage to US Armed Services members and their dependents) longitudinal claims data.PatientsWomen aged 18 years and above who underwent hysterectomy stratified into 4 racial groups: white, African American, Asian, and "other."InterventionReceipt of hysterectomy (TAH, TVH, or TLH).Measurements And Main ResultsWe used risk-adjusted multinomial logistic regression models to determine the relative risk ratios of receipt of TVH and TLH compared with TAH in each racial group compared with referent category of white patients for benign conditions. Among 33 015 patients identified, 60.82% (n = 20 079) were white, 26.11% (n = 8621) African American, 4.63% (n = 1529) Asian, and 8.44% (n = 2786) other. Most hysterectomies (83.9%) were for benign indications. Nearly 42% of hysterectomies (n = 13 917) were TAH, 27% (n = 8937) were TVH, and 30% (n = 10 161) were TLH. Overall, 36.37% of white patients received TAH compared with 53.40% of African American patients and 51.01% of Asian patients (p < .001). On multinomial logistic regression analyses, African American patients were significantly less likely than white patients to receive TVH (relative risk ratio [RRR], .63; 95% confidence interval [CI], .58-.69) or TLH (RRR, .65; 95% CI, .60-.71) compared with TAH. Similarly, Asian patients were less likely than white patients to receive TVH (RRR, .71; 95% CI, .60-.84) or TLH (RRR, .69; 95% CI, .58-.83) compared with TAH. Analyses by benign indications for surgery showed similar trends.ConclusionWe demonstrate that racial minority patients are less likely to receive a minimally invasive surgical approach compared with an open abdominal approach despite universal insurance coverage. Further work is warranted to better understand factors other than insurance access that may contribute to racial differences in surgical approach to hysterectomies.Copyright © 2017 AAGL. All rights reserved.

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