Surgical Care for Women with Endometrial Cancer in Florida.

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.