Objective To compare perioperative outcomes by patient race/ethnicity. Methods A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12–55 years in the USA between 2004–2014. Peripartum hysterectomy, in‐hospital mortality, perioperative complications, length of stay, and cost of hysterectomy data were analyzed using SAS. Results Among childbirth hospitalizations (52.9% white, 13.5% black, 23.0% Hispanic, 5.2% Asian, and 5.4% other), peripartum hysterectomy occurred in 6619. The incidence of peripartum hysterectomy was 90.3 (95% confidence interval [CI] 87.7–93.0) per 100 000 hospitalizations, and higher for black (111.0, 95% CI 104.5–117.4), Hispanic (104.9, 95% CI 99.1–110.8), and Asian women (119.6, 95% CI 109.1–130.2) compared to whites (75.7, 95% CI 72.8–78.5). After adjustment, Hispanic women had an 18% higher odds of undergoing peripartum hysterectomy (odds ratio [OR] 1.18, 95% CI 1.08–1.29; P=0.004) than white women. Non‐white women had a 2–3‐fold higher odds of in‐hospital mortality (ORblack 2.76, 95% CI 1.44–5.30; ORHispanic 1.99, 95% CI 1.04–3.82; ORAsian+other 2.44, 95% CI 1.11–5.40. Black and Asian/other women were more likely to undergo blood transfusions. Conclusion Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality.
The US Supreme Court overturned Roe v Wade in June 2022, and now each state's legislature will decide if and when its citizens will have legal access to abortion care and if and when its physicians will be criminalized for providing what is considered to be the standard of care by multiple health-related organizations. This extraordinary change in the medico-legal landscape requires reevaluation of health profession codes of ethics related to clinician conscience. This article argues that these codes must now be expanded to address 2 newly critical areas: physician advocacy to make abortion illegal and affirmative protection for "conscientious provision" in hostile environments on par with protection of conscientious refusal.
INTRODUCTION: The rate of peripartum hysterectomy (PH) is rising in the United States. Patient characteristics such as race and ethnicity have been identified as a predictor of other adverse perinatal outcomes such as preterm delivery and stillbirth. In order to determine possible predictors and disparities, different clinical and socio-economic characteristics were examined. METHODS: We conducted a retrospective cohort study of 9,082,034 women (weighted to represent over 43 million women) aged 12–55, who were hospitalized for childbirth using data from the National Inpatient Sample (2004–2014). We tested the association between patient race/ethnicity and receiving PH during the hospitalization, before and after adjustment for advanced age, year of hospitalization, socioeconomic and hospital-level factors, as well as other known clinical correlates of PH. RESULTS: In adjusted analyses, race/ethnicity remained a significant predictor of in-hospital PH for Black (OR=1.11; P<.05) and Hispanic (OR=1.18; P<.01) women compared to their white counterparts. Compared to women who are insured with an HMO or private insurance, women who are covered by Medicaid (OR 1.13) or are self pay (OR 1.23) were at statistically increased risk. Conversely, economic level, using zip code quartile as an indicator, was not a statistically significant predictor. CONCLUSION: Race/ethnicity has been found to be an independent predictor of PH, even after adjustment for clinical, socioeconomic and hospital factors. Future research should further investigate the reasons why certain women are at increased risk for receiving this high risk procedure, in order to develop and test interventions to improve peripartum outcomes.
INTRODUCTION: Peripartum hysterectomy (PH) is a lifesaving procedure known to have increased morbidity and mortality over elective hysterectomy. Non-white surgical patients frequently have poorer outcomes than white patients undergoing the same procedure. We sought to analyze patients undergoing PH and compare intraoperative and postoperative outcomes by race. METHODS: We performed a retrospective analysis of female patients (age 12–55) who underwent delivery of a newborn in a US hospital and had a subsequent peripartum hysterectomy during the same admission between 2005 and 2014. Data were obtained from the Healthcare Cost and Utilization Project's National Inpatient Sample. Demographic, clinical, socioeconomic and hospital characteristics of patients were compared with respect to patient race/ethnic group. RESULTS: Blacks undergoing PH were 3.1 times more likely to have any in-hospital mortality. This trend persisted between both Hispanic and Asian groups (2.1 times and 2.9 times more likely, respectively). After adjusting for covariates, in-hospital mortality and cardiopulmonary complications for Black and Asian women remained significantly higher than for whites. All races (Black, Hispanic, Asian) were more likely to undergo blood transfusion than their white counterparts. Blacks were 95% percent more likely to be diagnosed with sepsis during hospitalization. Additionally, surgical site infection was not statistically significant, however blacks were more likely (69.7%) to have wound dehiscence. CONCLUSION: Disparities in both intraoperative and postoperative outcomes following peripartum hysterectomy were observed. Future investigation must be performed in order to identify and eliminate any modifiable contributing factors on the provider or system level.
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