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

• Published in: American journal of obstetrics and gynecology 2022-06, Vol.226 (6), p.824.e1-824.e11
• Main Authors: Orlando, Megan S., Luna Russo, Miguel A., Richards, Elliott G., King, Cara R., Park, Amy J., Bradley, Linda D., Chapman, Graham C.
• Format: Article
• Language: English
• Subjects: chronic pelvic pain; endometriosis; Endometriosis - surgery; Ethnicity; Female; healthcare disparities; Hispanic or Latino; Humans; minimally invasive surgery; racial disparities; Retrospective Studies; United States - epidemiology; Whites
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2022.01.021

Despite an estimated 10% prevalence of endometriosis among reproductive-age women, surgical population-based data are limited. We sought to investigate racial and ethnic disparities in surgical interventions and complications among patients undergoing endometriosis surgery across the United States. We 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. We 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. Race and ethnicity were independently associated with surgical care for endometriosis, with elevated complication rates