Abstract C27: Socioeconomic status and racial differences in utilization of inpatient versus outpatient hysterectomy
Authors: Bahrani-Mostafavi Zahra , Huber Larissa R. Brunner , Shahbazi Sara , Naderi-Yeganeh Pourya 
Published: February 2019

Introduction: Hysterectomy is the second most common surgical procedure performed among reproductive aged women. The primary reason for hysterectomy among women 35-54 years is uterine fibroids; for older women the most common reasons are uterine prolapse or most gynecologic (GYN) cancers. According to the National Center for Health Statistics, an estimated 600,000 hysterectomies are performed annually in the U.S. with an annual cost of $5 billion, which makes hysterectomy a major public health concern. Moreover, hysterectomy is costly, with mean total patient costs of $30,000-45,000--depending on hysterectomy type, operative time, and the length of stay. The objective of this study is to identify the patient-level predictors of hysterectomy surgical approaches (inpatient [IP] vs. outpatient [OP]).

Methods: We used 2010-2012 Florida State Inpatient Database (SID) and State Ambulatory Surgery Database (SASD) of the Healthcare Cost and Utilization Project. Using ICD-9 and CPT coding systems, we restricted our study population (n=111,241) to those women who had hysterectomy procedures. Hysterectomies (IP and OP) were also stratified by type of procedure including abdominal (ABH), vaginal (VAH), and laparoscopic (LAH). Patient-level factors associated with the use of IP and OP hysterectomy were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of hysterectomy surgical approaches. Statistical analysis was conducted using SAS Version 9.4.

Results: The study population included women who underwent an IP or OP hysterectomy. About 70% of patients had IP hysterectomy, among which ABH was the most common procedure (47.02%). Among IP hysterectomy cases, higher percentage of patients was between 40-65 years of age (66.27%), white (61.95%), had private insurance (56.10%), and belonged to the lowest-income-level families (32.54%). The most common procedure among OP hysterectomy cases was LAH (87.70%). Among OP hysterectomy cases, higher percentage of patients was between 40-65 years of age (73.31%), white (70.30%), had private insurance (74.82%), and belonged to the third quartile of income level (32.85%). Logistics regression results indicate that Hispanic race, levels of income, older age, and pay categories (any other than Medicare, Medicaid, and private insurance) are statistically significant factors (p &lt;0.05) for determining hysterectomy type.

Conclusions: We found that ABH is the common hysterectomy type among patients who underwent an IP hysterectomy, while LAH is the common procedure for IP hysterectomies. The majority of hysterectomy patients (both IP and OP) were white, older adults, and those with private insurance. However, IP patients were from lowest-income-level families while OP patients were belonged to higher-income-level families. The findings suggest that OP facilities, although more available and affordable, are not commonly used by Medicare/Medicaid holders or by non-white women. Findings from this study highlight the importance of promoting optimal use of both hysterectomy approaches regardless of races/ethnicities and other socioeconomic factors, thus bringing better management of GYN cancer and improving women's health at large.

Note: This abstract was not presented at the conference.

Citation Format: Zahra Bahrani-Mostafavi, Larissa R. Brunner Huber, Sara Shahbazi, Pourya Naderi-Yeganeh. Socioeconomic status and racial differences in utilization of inpatient versus outpatient hysterectomy [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C27.