Comparing female veterans’ access to minimally invasive surgery in gender-neutral (appendectomy) vs. gender-specific operations (hysterectomy)

To compare the differences in access to a minimally invasive surgery (MIS) for gender-neutral (appendectomy) vs. gender-specific (hysterectomy) operation rapidly growing biologically female population at Veterans Health Administration (VHA). This is retrospective cohort study of biological veterans Affairs Surgical Quality Improvement Project (VASQIP) database who underwent appendectomy or hysterectomy benign indications from 2001-2021. Concurrent incidental procedures, malignancy, and complicated ruptured appendix were excluded. MIS included, vaginal laparoscopic approaches. Sociodemographic variables perioperative outcomes collected. All permutations routes hysterectomy, all open surgeries compared. Descriptive statistics used evaluate these groups baseline differences, potential confounders. A multivariable model was fit adjust relevant significant differences. 13,691 hysterectomies included: 52% (n=7095) (35% (n=4821) laparoscopic, 17% (n=2274) vaginal) 48% (n=6596) open. 2156 appendectomies included 84% (n=1810) (laparoscopic) 16% (n=346) See Table sociodemographic data. Significant between age, race, bmi, diabetes, sleep apnea, bleeding disorders, alcohol use, smoking, preop Hct, ASA class, functional status, sepsis, emergent need surgery. There also difference resident involvement, with being performed more often by attendings alone. When adjusting odds receiving remarkable OR 7.4 95%CI(5.3-10.5) p<.0001. Also notably, races twice as likely black women have ORs 1.9-2.1 p<.01. For (Table) abdominal had longer hospitalization higher risk complication, particularly infections (SSI, UTI pneumonia) vs MIS. no return OR, neurologic deficit, reintubation, VTE cardiac events. Female are 7 times receive approach operation. In addition, half than other races. calls action further support VHA gynecologic finding ways ensure equitable care veterans.Tabled 1SociodemographicsAge, years Median (min,max)Race:WhiteBlack African AmericanAsianAmerican Indian AlaskaNativeNative Hawaiian OtherPacific IslanderUnknown patientDeclined AnswerBMI (kg/m2)Median (P25,P75)Diabetes:NoneDiet ControlledOral AgentsInsulinSleep ApneaCOPDBleeding DisordersPreoperative SepsisASA class1234Functional StatusIndependentPartially DependentTotally DependentAlcohol Use >2drinks/dayCurrent SmokerPreoperative Hct %Median (P25,P75)Emergent SurgeryIntraoperative OutcomesTotal Operation Time, hours,Median (P25,P75)Attending role:Performed aloneAssisted ResidentPresent (not scrubbed)Immediately AvailableWound Class:CleanClean/ContaminatedContaminatedInfectedIntraoperative TransfusionPostoperative OutcomesPostoperative Hospital Stay (days) mean (95%CI)≥1 surgical complicationsReturn <30 daysWound infection (Superficial Deep SSI)Postop Hematocrit (%)Median (P25,P75)Pulmonary EmbolusPostop PneumoniaUTIMISAppendectomyN= 181044 (18,97)71.8% (1219/1696)16.9% (286/1696)1.4% (24/1696)1.5% (25/1696)1.4% (23/1696)2.2% (38/1696)4.8% (81/1696)28.9 (25.0-33.8)89.8% (1133/1262)1.5% (19/1262)4.4% (55/1262)4.4% (55/1262)11.5% (160/1391)3.0% (54/1810)2.6% (47/1810)4.2% (76/1810)11.6% (210/1810)56.6% (1025/1810)30.7% (555/1810)1.1% (20/1810)97.5% (1766/1810)2.4% (43/1810)0.1% (1/1810)2.8% (51/1810)28.0% (507/1808)39.1 (36.7,41.6)55.6% (1006/1810)1.0 (0.8,1.4)29.1% (504/1735)61.0% (1059/1735)9.3% (161/1735)0.6% (11/1735)8.9% (160/1810)58.9% (1066/1810)19.6% (354/1810)12.7% (230/1810)0.1% (2/1810)2.1(1.9- 2.2)4.5% (82/1810)1.5% (27/1810)2.1%(37/1810)34.2 (31.5,36.9)00.1% (1/1810)0.5% (9/1810)OpenAppendectomyN=34646 (18,88)68.9% (197/286)20.3% (58/286)0.4% (1/286)0.4% (1/286)2.5% (7/286)5.2% (15/286)2.5% (7/286)28.9 (24.2,33.1)88% (88/100)2.0% (2/100)5.0% (5/100)5.0% (5/100)11.7% (16/137)4.1% (14/346)2.3% (8/346)6.1% (21/346)11.0% (38/346)57.5% (199/346)29.8% (103/346)1.7% (6/346)97.4% (337/346)2.6% (9/346)0% (0/346)2.9% (10/346)33.2% (115/346)39.2 (36.6,41.6)73.4% (254/346)1.0 (0.8,1.5)36.7% (97/264)58.7% (155/264)3.8% (10/264)0.8% (2/264)14.2 % (49/346)55.5% (192/346)17.9% (62/346)12.4% (43/346)03.3 (2.8-3.9)5.8% (20/346)2.0 (7/346)3.5%(12/346)33.1 (30.5,35.5)0.1% (2/1810)0.3% (1/346)0.6% (2/346)MISHysterectomyN=709543 (23,87)55.6% (2681/6627)34.7% (2298/6627)0.9% (63/6627)1.4% (93/6627)1.0% (66/6627)1.9% (123/6627)4.6% (303/6627)30.0 (25.9,34.3)90.8% (4949/5448)2.0% (106/5448)5.4% (297/5448)1.8% (96/5448)15.0% (877/5852)1.3% (91/7095)1.1% (81/7095).01% (1/7095)4.8% (337/7095)65% (4612/7095)30.1% (2135/7095)0.2% (11/7095)99.6% (7063/7095)0.4% (29/7095)0.1% (3/7095)2.1% (151/7095)26.3% (1867/7095)39.3 (36.8,41.5)0.2% (12/7095)2.3 (1.7,3)58.1% (3866/6662)39.4% (2624/6662)2.5% (166/6662)0.1% (6/6662)5.0% (351/7095)94.1% (6679/7095)0.8% (59/7095).1% (6/7095)0.9% (66/7095)1.5 (1.4-1.5)4.2% (302/7095)1.5% (108/7095)0.8% (57/7095)33.3 (30.6,36)0.2% (14/7095)0.1% (5/7095)2.0% (143/7095)OpenHysterectomyN=659644 (23,81)40.8% (2318/5686)50.2% (2854/5686)0.5% (30/5686)0.9% (49/5686)0.8% (47/5686)2.7% (152/5686)4.2% (236/5686)30.5 (26.7,39.4)91.0% (2362/2595)1.7% (44/2595)5.4% (140/2595)1.9% (49/2595)12.7% (406/3188)2.0% (131/6596)1.6% (104/6596).09% (6/6596)5.0% (332/6596)62.9% (4148/6596)31.8% (2095/6596)0.3% (21/6596)99.3% (6554/6596)0.6% (40/6596)0.1% (2/6596)3.1% (207/6593)30.0% (1976/6596)38.2 (35.5,40.8)0.4% (23/6596)2.0 (1.5,2.6)63.1% (3460/5486)35.2% (1930/5486)1.7% (92/5486)0.1 (4/5486)20.8% (1373/6596)78.8% (5195/6596)0.3% (18/6596)0.2% (10/6596)2.7% (180/6596)2.7 (2.7-2.8)6.5% (426/6596)1.9% (127/6596)2.5% (165/6596)31.7 (28.3,34.5)0.3% (18/6596)0.3% (17/6596)2.3% (153/6596)P- value<.0001<.0001<.0001<.0001<.0001<.0001<.0001<.0001<.0001<.0001.003<.0001<.0001<.0001<.0001<.0001<.0001<.0001<.0001<.00010.25<.001<.00010.4.02<.0001 Open table new tab