Disparities in Utilization of Laparoscopic Procedures: A Military-wide Analysis

Background: Despite a clear indication in many cases for the less invasive procedure, previous studies that have looked at the trends in the national distribution of laparoscopic hysterectomies have found that there remains a gap in the distribution of laparoscopic hysterectomies with regard to age, race, median income and insurance type. Objective: The purpose of this study was to examine the impact of race and military rank on access to the type of surgery performed and the use of minimally invasive surgery in the military. Method: Retrospective cohort study. Results: There was a marked disparity in racial utilization of surgical procedures. After controlling for age (OR=1.01/year, p <.001) and encounter year, total abdominal hysterectomy was less likely in White patients than Black patients (OR=.43, p<.0001) or Asian patients (OR=.428, p<.0001), but of equivalent likelihood in Black and Asian patients (OR=1.02, p=.98). Models testing the effect of rank for each of the surgical procedures revealed no effect on the rates of laparoscopic hysterectomy( LH) (OR=1.13, p=.09), total vaginal hysterectomy(TVH) (OR=.96, p=.60) or total abdominal hysterectomy(TAH) (OR=.91, p=.21). Conclusion: Future research should carefully consider whether the access to laparoscopic hysterectomy is related to race, ethnicity or socioeconomic status. Other circumstances, such as etiology of disease, uterine weight, and BMI may also be contributing factors in disparities in the utilization of laparoscopic hysterectomies. Further investigation is warranted to study the existing disparities.