Laparoscopy decreases the disparity in postoperative complications between black and white women after hysterectomy for endometrial cancer

Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic p...

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Veröffentlicht in:	Gynecologic oncology Jg. 149; H. 1; S. 22 - 27
Hauptverfasser:	Lee, Jessica, Gerber, Deanna, Aphinyanaphongs, Yindalon, Curtin, John P., Boyd, Leslie R.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Inc 01.04.2018
Schlagworte:	Black or African American Black People - statistics & numerical data Endometrial cancer Endometrial Neoplasms - ethnology Endometrial Neoplasms - surgery Female Healthcare Disparities - statistics & numerical data Humans Hysterectomy Hysterectomy - adverse effects Hysterectomy - methods Hysterectomy - statistics & numerical data Laparoscopy Laparoscopy - adverse effects Laparoscopy - methods Laparoscopy - statistics & numerical data Middle Aged Postoperative Complications - epidemiology Postoperative Complications - ethnology Postoperative Complications - etiology Racial disparity United States - epidemiology White People - statistics & numerical data United States Laparoscopy Hysterectomy Endometrial cancer Racial disparity
ISSN:	0090-8258, 1095-6859, 1095-6859
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Abstract	Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes. A total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1). Overall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer. •Rates of laparoscopy for the treatment of endometrial cancer are lower in blacks.•Blacks have higher BMIs and have more preoperative comorbidities than whites.•The rates of postoperative complications after any hysterectomy are higher in blacks.•The rates of postoperative complications after laparoscopic hysterectomy are similar.
AbstractList	Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes. A total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1). Overall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer. Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes. Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes. A total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1). Overall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer. •Rates of laparoscopy for the treatment of endometrial cancer are lower in blacks.•Blacks have higher BMIs and have more preoperative comorbidities than whites.•The rates of postoperative complications after any hysterectomy are higher in blacks.•The rates of postoperative complications after laparoscopic hysterectomy are similar. Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes.OBJECTIVESBlack race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes.Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes.METHODSUsing the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes.A total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1).RESULTSA total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1).Overall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer.CONCLUSIONSOverall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer.
Author	Gerber, Deanna Boyd, Leslie R. Lee, Jessica Aphinyanaphongs, Yindalon Curtin, John P.
Author_xml	– sequence: 1 givenname: Jessica orcidid: 0000-0002-3788-5741 surname: Lee fullname: Lee, Jessica email: jessica.lee2@nyumc.org organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 2 givenname: Deanna surname: Gerber fullname: Gerber, Deanna organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 3 givenname: Yindalon surname: Aphinyanaphongs fullname: Aphinyanaphongs, Yindalon organization: New York University, Center for Health Informatics and Bioinformatics, 227 East 30th Street, New York, NY, USA – sequence: 4 givenname: John P. surname: Curtin fullname: Curtin, John P. organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA – sequence: 5 givenname: Leslie R. surname: Boyd fullname: Boyd, Leslie R. organization: New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA
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Keywords	Laparoscopy Hysterectomy Endometrial cancer Racial disparity
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Snippet	Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to...
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SubjectTerms	Black or African American Black People - statistics & numerical data Endometrial cancer Endometrial Neoplasms - ethnology Endometrial Neoplasms - surgery Female Healthcare Disparities - statistics & numerical data Humans Hysterectomy Hysterectomy - adverse effects Hysterectomy - methods Hysterectomy - statistics & numerical data Laparoscopy Laparoscopy - adverse effects Laparoscopy - methods Laparoscopy - statistics & numerical data Middle Aged Postoperative Complications - epidemiology Postoperative Complications - ethnology Postoperative Complications - etiology Racial disparity United States - epidemiology White People - statistics & numerical data
Title	Laparoscopy decreases the disparity in postoperative complications between black and white women after hysterectomy for endometrial cancer
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