title: Health Care Disparities in Hysterectomy for Gynecologic Cancers: Data From the 2012 National Inpatient Sample.
abstract: OBJECTIVE
  To examine hysterectomies in the United States performed for gynecologic malignancies and identify factors associated with the use of minimally invasive techniques.
  
  
  METHODS
  This is a cross-sectional analysis of the 2012 National Inpatient Sample, the largest national all-payer database of hospital discharges. International Classification of Diseases, 9th Revision, Clinical Modification codes for any type of hysterectomy performed for gynecologic malignancy were used to abstract pertinent observations. Weighted multivariable logistic regression models were used to examine the associations between demographic and clinical factors and mode of hysterectomy by cancer diagnosis.
  
  
  RESULTS
  In 2012, there were an estimated 46,450 hysterectomies for gynecologic malignancy in the United States. Of these, 28,285 (61%) were performed for uterine, 4,275 (9%) for cervical, 12,370 (27%) for ovarian cancer, and 1,520 (3%) for other gynecologic malignancies. Minimally invasive hysterectomy was used in 50% of uterine, 43% of cervical, and 8.5% of ovarian cancer cases. Black women had decreased odds of undergoing minimally invasive hysterectomy for uterine (adjusted odds ratio [OR] 0.50, 95% confidence interval [CI] 0.40-0.0.63, P<.001) and cervical (adjusted OR 0.56, 95% CI 0.33-0.96, P=.03) cancers. Those without insurance or with Medicaid had decreased odds of undergoing minimally invasive hysterectomy (P<.001) for uterine cancer. As compared with the Northeast, patients in the South (adjusted OR 0.72, 95% CI 0.53-0.98, P=.04) were less likely to undergo minimally invasive hysterectomy for uterine cancer, whereas those in the West more likely (adjusted OR 1.48, 95% CI 1.10-1.99, P=.009).
  
  
  CONCLUSIONS
  Minimally invasive hysterectomy for gynecologic malignancies remained underused in 2012; there were striking racial disparities associated with use of minimally invasive hysterectomy for uterine and cervical cancers.
  
  
  METHODS
  III.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, and the Obstetrics and Gynecology Epidemiology Center and the Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Esselen
authors.forename: Allison
authors.initials: A
authors.lastname: Vitonis
authors.forename: Jon
authors.initials: J
authors.lastname: Einarsson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
authors.forename: Sarah
authors.initials: S
authors.lastname: Cohen
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010051:Ovarian Neoplasms / Q000601:surgery*; D014481:United States; D014594:Uterine Neoplasms / Q000601:surgery*