Objective:
To estimate the associations between race, route of hysterectomy and postoperative complications among women undergoing benign hysterectomy.
Methods:
A cohort study was performed. All patients undergoing benign hysterectomy, recorded in the National Surgical Quality Improvement Program (NSQIP) and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression.
Results:
Of 15,136 women who underwent benign hysterectomy, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs. 22.9%; OR: 3.36, 95%CI: 3.11–3.64). Black women had larger uteri (median 262g vs. 123g; 60.7% vs. 25.6% with uterus >250g), more prior pelvic surgery (58.5% vs. 53.2%) and higher BMIs (32.7 vs. 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (aOR: 2.02, 95%CI: 1.85–2.20). Black women experienced more major complications than white women (4.1% vs. 2.3%; p<0.001) and more minor complications (11.4% vs. 6.7%; OR: 1.78, p<0.001). Again these disparities persisted with adjustment (major aOR: 1.56, 95%CI: 1.25–1.95; minor aOR: 1.27, 95%CI: 1.11–1.47).
Conclusions:
Back women have a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.
Objective
To examine the relationship between sleep disordered breathing (SDB) and adverse pregnancy outcomes in a high-risk cohort
Study Design
This was a planned analysis of a prospective cohort designed to estimate the prevalence and trends of SDB in a high-risk pregnant women. We recruited women with a BMI ≥ 30 kg/m2, chronic hypertension, pre-gestational diabetes, prior preeclampsia, and/or a twin gestation. Objective assessment of SDB was completed between 6–20 weeks and again in the third trimester. SDB was defined as an apnea hypopnea index ≥5, and further grouped into severity categories: mild SDB (5–14.9), moderate SDB (15–29.9) and severe SDB (≥30). Pregnancy outcomes (preeclampsia, gestational diabetes, preterm birth, infant weight) were abstracted by physicians blinded to the SDB results.
Results
Of the 188 women with a valid early pregnancy sleep study, 182 had complete delivery records. There was no relationship demonstrated between SDB exposure in early or late pregnancy and preeclampsia, preterm birth < 34 weeks, and small for gestational age (<5%) or large for gestational age (>95%) neonates. Conversely, SDB severity in early pregnancy was associated with the risk of developing gestational diabetes (no SDB 25%, mild SDB 43%, moderate/severe SDB 63%, p=.03). The adjusted OR for developing gestational diabetes for moderate/severe SDB was 3.6 (0.6, 21.8).
Conclusions
This study suggests a dose-dependent relationship between SDB in early pregnancy and the subsequent development of gestational diabetes. In contrast, no relationships between SDB during pregnancy and preeclampsia, preterm birth, and extremes of birthweight were demonstrated.
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