Surgical Care for Women with Endometrial Cancer in Florida

Osayande Osagiede, Christopher Destephano, Jordan J. Cochuyt, Dorin T. Colibaseanu, Matthew A. Robertson, Aaron Spaulding

Research output: Contribution to journalArticle

Abstract

Objective: The goal of this research was to analyze if disparities in route of hysterectomy for endometrial cancer exist in Florida. Materials and Methods: In this retrospective cohort study, Florida inpatient and ambulatory surgery databases (2014-2016) were examined to find cases of patients with endometrial cancer who underwent hysterectomy in the state. Logistic regression models were used to compare patient-and hospital-level factors associated with having minimally invasive surgery (MIS) versus open surgery, and complications in patients having open hysterectomy versus MIS. Results: Overall, 6513 patients met the inclusion criteria. MIS was performed in 81.4% of cases. The odds of using a minimally invasive approach to hysterectomy (vaginal, robotic, or laparoscopic) were significantly lower for black women (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.50) as well as for other non-white patients (OR: 0.64; 95% CI: 0.49-0.84). Patients with Medicaid (OR: 0.42; 95% CI: 0.30-0.59) or Medicare managed care (OR: 0.73; 95% CI: 0.59-0.91), or who received care at a teaching hospital (OR: 0.82; 95% CI: 0.68-0.98) or government hospital (OR: 0.50; 95% CI: 0.38-0.65) were also less likely to receive MIS. Patients receiving care at a high-volume (OR: 1.69; 95% CI: 1.30-2.20) or medium-volume (OR: 3.11; 95% CI: 2.37-4.08) hospital, or patients who were located in the Central (OR: 1.71; 95% CI: 1.17-2.48) or Peninsula (OR: 1.73; 95% CI: 1.17-2.56) regions, compared to the Florida Panhandle, had greater odds of receiving MIS. Conclusions: Although Florida has a high adoption of MIS for treating endometrial cancer, disparities persist. Efforts of state-level entities should focus on improving access to minimally invasive hysterectomy for racial minorities with endometrial cancer.

Original languageEnglish (US)
Pages (from-to)163-171
Number of pages9
JournalJournal of Gynecologic Surgery
Volume35
Issue number3
DOIs
StatePublished - Jun 1 2019

Fingerprint

Endometrial Neoplasms
Odds Ratio
Minimally Invasive Surgical Procedures
Confidence Intervals
Hysterectomy
Logistic Models
Vaginal Hysterectomy
Medicaid
Managed Care Programs
Robotics
Medicare
Ambulatory Surgical Procedures
Teaching Hospitals
Inpatients
Patient Care
Cohort Studies
Retrospective Studies
Databases

Keywords

  • endometrial cancer
  • health disparities
  • hysterectomy
  • minimally invasive surgery

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

Cite this

Surgical Care for Women with Endometrial Cancer in Florida. / Osagiede, Osayande; Destephano, Christopher; Cochuyt, Jordan J.; Colibaseanu, Dorin T.; Robertson, Matthew A.; Spaulding, Aaron.

In: Journal of Gynecologic Surgery, Vol. 35, No. 3, 01.06.2019, p. 163-171.

Research output: Contribution to journalArticle

Osagiede, Osayande ; Destephano, Christopher ; Cochuyt, Jordan J. ; Colibaseanu, Dorin T. ; Robertson, Matthew A. ; Spaulding, Aaron. / Surgical Care for Women with Endometrial Cancer in Florida. In: Journal of Gynecologic Surgery. 2019 ; Vol. 35, No. 3. pp. 163-171.
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abstract = "Objective: The goal of this research was to analyze if disparities in route of hysterectomy for endometrial cancer exist in Florida. Materials and Methods: In this retrospective cohort study, Florida inpatient and ambulatory surgery databases (2014-2016) were examined to find cases of patients with endometrial cancer who underwent hysterectomy in the state. Logistic regression models were used to compare patient-and hospital-level factors associated with having minimally invasive surgery (MIS) versus open surgery, and complications in patients having open hysterectomy versus MIS. Results: Overall, 6513 patients met the inclusion criteria. MIS was performed in 81.4{\%} of cases. The odds of using a minimally invasive approach to hysterectomy (vaginal, robotic, or laparoscopic) were significantly lower for black women (odds ratio [OR]: 0.41; 95{\%} confidence interval [CI]: 0.34-0.50) as well as for other non-white patients (OR: 0.64; 95{\%} CI: 0.49-0.84). Patients with Medicaid (OR: 0.42; 95{\%} CI: 0.30-0.59) or Medicare managed care (OR: 0.73; 95{\%} CI: 0.59-0.91), or who received care at a teaching hospital (OR: 0.82; 95{\%} CI: 0.68-0.98) or government hospital (OR: 0.50; 95{\%} CI: 0.38-0.65) were also less likely to receive MIS. Patients receiving care at a high-volume (OR: 1.69; 95{\%} CI: 1.30-2.20) or medium-volume (OR: 3.11; 95{\%} CI: 2.37-4.08) hospital, or patients who were located in the Central (OR: 1.71; 95{\%} CI: 1.17-2.48) or Peninsula (OR: 1.73; 95{\%} CI: 1.17-2.56) regions, compared to the Florida Panhandle, had greater odds of receiving MIS. Conclusions: Although Florida has a high adoption of MIS for treating endometrial cancer, disparities persist. Efforts of state-level entities should focus on improving access to minimally invasive hysterectomy for racial minorities with endometrial cancer.",
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N2 - Objective: The goal of this research was to analyze if disparities in route of hysterectomy for endometrial cancer exist in Florida. Materials and Methods: In this retrospective cohort study, Florida inpatient and ambulatory surgery databases (2014-2016) were examined to find cases of patients with endometrial cancer who underwent hysterectomy in the state. Logistic regression models were used to compare patient-and hospital-level factors associated with having minimally invasive surgery (MIS) versus open surgery, and complications in patients having open hysterectomy versus MIS. Results: Overall, 6513 patients met the inclusion criteria. MIS was performed in 81.4% of cases. The odds of using a minimally invasive approach to hysterectomy (vaginal, robotic, or laparoscopic) were significantly lower for black women (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34-0.50) as well as for other non-white patients (OR: 0.64; 95% CI: 0.49-0.84). Patients with Medicaid (OR: 0.42; 95% CI: 0.30-0.59) or Medicare managed care (OR: 0.73; 95% CI: 0.59-0.91), or who received care at a teaching hospital (OR: 0.82; 95% CI: 0.68-0.98) or government hospital (OR: 0.50; 95% CI: 0.38-0.65) were also less likely to receive MIS. Patients receiving care at a high-volume (OR: 1.69; 95% CI: 1.30-2.20) or medium-volume (OR: 3.11; 95% CI: 2.37-4.08) hospital, or patients who were located in the Central (OR: 1.71; 95% CI: 1.17-2.48) or Peninsula (OR: 1.73; 95% CI: 1.17-2.56) regions, compared to the Florida Panhandle, had greater odds of receiving MIS. Conclusions: Although Florida has a high adoption of MIS for treating endometrial cancer, disparities persist. Efforts of state-level entities should focus on improving access to minimally invasive hysterectomy for racial minorities with endometrial cancer.

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