Racial, Socioeconomic and Geographic Disparities in the Selection of Minimally Invasive Approaches Versus Open Abdominal Hysterectomy: A Systematic Review and Meta-Analysis Protocol

Abstract

Background: Minimally invasive hysterectomy (MIH), including vaginal, laparoscopic, and robotic approaches, is associated with improved perioperative outcomes compared with open abdominal hysterectomy and is now the preferred surgical approach for many benign gynecologic conditions. However, emerging evidence suggests that access to MIH is not equitably distributed, with disparities observed across racial, socioeconomic, and geographic groups.

Objectives: This systematic review and meta-analysis will aim to evaluate and quantify disparities in the use of minimally invasive versus open abdominal hysterectomy among women undergoing surgery for benign conditions. Specifically, it will estimate pooled associations by race/ethnicity, socioeconomic status, and geographic or hospital-level factors.

Methods: This protocol follows PRISMA-P guidelines and has been registered in PROSPERO. We will systematically search PubMed, Scopus, and Web of Science (2010–2026) for observational studies reporting hysterectomy route in relation to racial/ethnic, socioeconomic, or geographic variables. Eligible studies will include adult women undergoing hysterectomy for benign indications. Two reviewers will independently screen studies, extract data, and assess risk of bias using JBI tools. Random-effects meta-analyses will be conducted to pool adjusted effect estimates. Heterogeneity will be assessed using I2 and Cochran’s Q. Subgroup and sensitivity analyses will explore clinical eligibility, health system characteristics, and hospital-level factors.

Ethical Considerations: This systematic review and meta-analysis will rely solely on data obtained from existing published studies, with no direct interaction with human subjects, no collection of personally identifiable information, and no additional intervention beyond the secondary analysis of summarized results. Therefore, official approval from an institutional review board or research ethics committee is typically not necessary.