Why does race affect surgery procedures?

 
I found this article interesting.  It discusses how race seems to be a factor in type of hysterectomy surgery performed.  These numbers are American so I would be interested to know if such statistics would be true elsewhere.

Race, ethnicity influence chances of minimally invasive hysterectomy

By: MICHELE G. SULLIVAN, Internal Medicine News Digital Network

NATIONAL HARBOR, MD. – Race and ethnicity still appear to play a role in determining which patients receive a minimally invasive hysterectomy, and which undergo a traditional abdominal procedure.

Black, Hispanic, and Asian women were up to 50% less likely to have either a laparoscopic or vaginal hysterectomy, compared with whites, Dr. Katharine Esselen reported at the AAGL global congress.

The findings remained statistically significant even after Dr. Esselen and her colleagues controlled for a variety of patient, financial, and hospital characteristics.

“Racial disparities exist in the mode of hysterectomy in endometrial and cervical cancer, and must be further investigated to better understand the contributing factors so that they may be eradicated,” said Dr. Esselen, a clinical fellow in gynecologic oncology at Brigham and Women’s Hospital, Boston.

The researchers extracted their data from the 2009 National Inpatient Sample. It included 1,000 hospitals and more than 8 million patient stays – representing 20% of the discharges in the country for that year.

In 2009, there were 64,410 hysterectomies performed for gynecologic malignancy. More than half (54%) were for endometrial cancer, followed by cervical cancer (23%), and ovarian cancer (19%). Other cancers made up the remainder.

The majority of surgeries in all these categories were abdominal: 72% of the endometrial cases, 56% of the cervical cases, and 95% of the ovarian cases. Laparoscopic hysterectomy was the surgical mode in 26% of endometrial cases, 23% of cervical cases, and 4% of ovarian cases. Vaginal hysterectomies were performed for 2% of endometrial cases, 21% of vaginal cases, and just 1% of ovarian cases.

A multivariate regression analysis controlled for demographic factors (age, race/ethnicity, insurance); patient factors (cancer diagnosis, fibroids, endometriosis, prolapse, menstrual disorders, age, severity of comorbidities, obesity); and hospital factors (urban/rural, teaching status, size, and region of country).

After adjustment for all of these factors, black women were 43% less likely to have a minimally invasive hysterectomy for endometrial cancer than were white women – a significant difference. Hispanic and Asian women were also significantly less likely to have minimally invasive surgery (MIS), with odds ratios of 0.61 and 0.63, respectively. Native American women, however, were more than five times as likely to have such a procedure compared with white women (OR, 5.26).

Insurance also played a role, Dr. Esselen said. Those with Medicaid were significantly less likely to have a minimally invasive procedure (OR, 0.64) than were those with private insurance.

The findings were similar for ovarian cancer. Black and Asian women were significantly less likely to have MIS than were whites (OR, 0.41 and 0.44, respectively). There was no significant difference seen for Hispanic women.

Medical comorbidities were significantly related to the chance of MIS as well. MIS was significantly less likely in women with moderate loss of function due to comorbid conditions (endometrial OR, 0.47; cervical OR, 0.62; ovarian OR, 0.38). Those with major to extreme loss of function had an even smaller chance (endometrial OR, 0.23; cervical OR, 0.21; ovarian OR, 0.10). The P values on these were all less than .0001.

Obesity only affected MIS odds in endometrial cancer, significantly increasing the chance of such a procedure (OR, 1.27).

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Types of Hysterectomy

This appears to be one of the most misunderstood aspects of hysterectomy.  I was not clear on this either, before I had a hysterectomy.  I found people would hear about my surgery and then would label it with terms that they were familiar with but did not accurately describe my surgery.  Here are the three types of hysterectomy surgeries as found on the Mayo Clinic Site:Image

Supra-cervical hysterectomy (also referred to as a partial or subtotal hysterectomy): This is the removal of the upper part of the uterus only and leaves the cervix in place (first image pictured above).

Total hysterectomy:  This involves the removal of the uterus and cervix and is the procedure I had (bottom left image).  However, if I told people I had a total hysterectomy they assumed that meant the removal of ‘everything’ which is actually a:

Radical hysterectomy: involve removal of the uterus, cervix, fallopian tubes and ovaries (far right image).  This occurs most often when cancer is present.

To add to the confusion, these are types of hysterectomy based on what is removed.  Types of hysterectomy can also be classified based on the type of surgery performed.  More on that in the next post!

The Big 5-0

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No, I’m not turning 50 for awhile yet.  However, I just finished my 50th post on this blog!  I wasn’t sure when I started if I would have enough information to share for very long.  However, there always seems to be more information available and more people writing on this topic.  This is a very good thing!  I’m glad these issues are being discussed more often.  Having a hysterectomy can be a big moment in a woman’s life.  There needs to be information available to them to help make this process more comfortable.  I hope this blog meets that need in some way.  If you know of anyone who might benefit from this type of information (here comes the shameless plug!) please feel free to share this blog with them.  Also, if you have thoughts about what topics need further discussion on this blog, please feel free to let me know.  Thanks for reading!

Hysterectomy Does Not Increase Risk of Cardiovascular Disease, Study Finds

blog pic 25Here is some good news for those of you needing a hysterectomy (or who have already had one).  Contrary to earlier reports, it seems like there is not a link between having a hysterectomy and an increase in cardiovascular disease.  Read on for more information about this recent study.

May 14, 2013 — Having a hysterectomy with or without ovary removal in mid-life does not increase a woman’s risk of cardiovascular disease compared to women who reach natural menopause, contrary to many previously reported studies, according to research published online today in the Journal of the American College of Cardiology.

“Middle-aged women who are considering hysterectomy should be encouraged because our results suggest that increased levels of cardiovascular risk factors are not any more likely after hysterectomy relative to after natural menopause,” said Karen A. Matthews, PhD, lead author of the study and a distinguished professor of psychiatry and professor of epidemiology and psychology at the University of Pittsburgh.

Hysterectomy is the surgical removal of a woman’s uterus; it is sometimes accompanied by the removal of the ovaries to decrease the risk of ovarian cancer. Hysterectomy is a common surgical procedure for women, but the benefits must be weighed against potential long-term related health consequences. Cardiovascular disease is the number one killer of women and many studies have shown increased risk of cardiovascular disease to be a health risk associated with hysterectomy, especially accompanied by ovary removal. Researchers in those studies usually evaluated cardiovascular disease risk factors years after hysterectomy and/or ovary removal and did not assess individual risk factor levels pre-surgery.

For this study, investigators followed 3,302 premenopausal women between the ages of 42-52 for 11 years who were enrolled in the Study of Women’s Health across the Nation (SWAN). Researchers compared cardiovascular disease risk factors in women prior to and following elective hysterectomy with or without ovary removal to the risk factors prior to and following final menstrual period in women who underwent natural menopause.

This is the only multiethnic study that has tracked prospective annual changes in cardiovascular disease risk factors relative to hysterectomy or natural menopause.

Investigators found that several cardiovascular disease risk factor changes differed prior to and following hysterectomy, compared to changes prior to and following a natural menopause, but those changes did not suggest an increased cardiovascular disease risk following hysterectomy, independent of body mass index, which did increase after hysterectomy with removal of ovaries. These effects were similar in all ethnic groups in the study.

Dr. Matthews said it is unclear why this study’s findings differed from other studies exploring hysterectomy and cardiovascular risk, but likely factors include the age of participants since hysterectomy that occurs earlier in life may present more cardiovascular risk. Also, earlier studies included women who had hysterectomy for any reason, whereas the SWAN study excluded women who had hysterectomy because of cancers.

“This study will prove very reassuring to women who have undergone hysterectomy,” said American College of Cardiology CardioSmart Chief Medical Expert JoAnne Foody, MD, FACC. “As with anything, if a woman is concerned about her risk for heart disease she should discuss this with her health care provider.”

Found at: http://www.sciencedaily.com/releases/2013/05/130514185330.htm