Racial Differences in Planned Hysterectomy Procedure Route.
Racial Differences in Planned Hysterectomy Procedure Route.
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计划的子宫切除手术路线的种族差异。
DOI：
10.1089/jwh.2021.0132
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Wegienka,Ganesa
中科院分区：
文献类型：
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作者：
Su,Wan-TingK;Coleman,ChadM;Bossick,AndrewS;Lee-Griffith,Monica;Wegienka,Ganesa
背景：子宫切除术可以通过微创手术（MIS）方法或剖腹手术（腹部）方法进行。本研究的目的是评估计划进行 MIS 子宫切除术的可能性的种族差异。材料和方法：对在亨利·福特卫生系统接受子宫切除术的妇女进行了一项前瞻性队列研究，所有患者都可以使用剖腹手术和 MIS 方法。所有手术均在 2015 年 10 月至 2017 年 8 月期间进行。在这项研究中，女性被要求报告人口统计和保险信息，并在子宫切除术前 2 周以及子宫切除术后一年内完成最多六次经过验证的调查问卷。从电子健康记录中收集临床和手术特征。应用 Logistic 回归和多项 Logistic 回归模型来评估种族与手术方法之间的关联。结果：分析包括 235 名白人女性和 196 名黑人女性。黑人女性计划进行子宫切除术（比值比 [OR] = 0.46，95% 置信区间 [CI] 0.3–0.71，p< 0.05）、腹腔镜子宫切除术（相对风险比 [RRR] = 0.46，95% CI）的可能性较小0.29–0.73，p< 0.05），或与白人女性相比，阴道子宫切除术（RRR = 0.45，95% CI 0.25–0.81，p= 0.01）。调整混杂因素、子宫重量和肌瘤手术指征后，这些种族差异不再具有统计学显着性（MIS 与腹部手术[调整后的比值比 {aOR} = 0.93, 95% CI 0.55–1.57,p= 0.79]，腹腔镜与腹部手术[调整后的相对风险比 {aRRR} = 0.89, 95% CI 0.52–1.51，p= 0.54]，以及阴道与腹部 [aRRR = 1.22，95% CI 0.61–2.45，p= 0.58]）。这些关联并没有被关于抑郁、财务困境和决策满意度的标准化问卷的基线调查数据所混淆。结论：在控制了重要的混杂变量后，黑人女性计划进行 MIS 子宫切除术的可能性并不比白人女性低。这些结果强调了在研究种族差异时考虑所有重要混杂因素的重要性。
Background:Hysterectomies can be performed with a minimally invasive surgical (MIS) approach or a laparotomic (abdominal) approach. The objective of this study was to assess any racial differences in the likelihood of having a planned MIS hysterectomy.Materials and Methods:A prospective cohort study of women undergoing hysterectomy at Henry Ford Health System was conducted where laparotomic and MIS approaches are available to all patients. All procedures were performed between October, 2015, and August, 2017. For this study, women were asked to report demographic and insurance information and complete validated questionnaires from 2 weeks before hysterectomy and up to six additional times in the year after hysterectomy. Clinical and operative characteristics were collected from electronic health records. Logistic regression and multinomial logistic regression models were applied to assess the association between race and the surgical approach.Results:Analyses included 235 White women and 196 Black women. Black women were less likely to have any MIS planned for their hysterectomy (odds ratio [OR] = 0.46, 95% confidence interval [CI] 0.3–0.71,p< 0.05), a laparoscopic hysterectomy (relative risk ratio [RRR] = 0.46, 95% CI 0.29–0.73,p< 0.05), or a vaginal hysterectomy (RRR = 0.45, 95% CI 0.25–0.81,p= 0.01) compared with White women. After adjusting for confounders, uterine weight and indication for surgery was fibroids, these racial differences did not remain statistically significant (MIS vs. abdominal [adjusted odds ratio {aOR} = 0.93, 95% CI 0.55–1.57,p= 0.79], laparoscopic vs. abdominal [adjusted relative risk ratio {aRRR} = 0.89, 95% CI 0.52–1.51,p= 0.54], and vaginal vs. abdominal [aRRR = 1.22, 95% CI 0.61–2.45,p= 0.58]). The associations were not confounded by the baseline survey data from standardized questionnaires on depression, financial distress, and satisfaction with their decision.Conclusions:Black women were not less likely than White women to have planned an MIS hysterectomy after controlling for important confounding variables. These results emphasize the importance of considering all important confounders when examining racial differences.