Racial Disparities in Surgical Outcomes During Peripartum Hysterectomy [26J]

Abstract

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.

The global proliferation of radical gynaecological surgeries: A history of the present

“…A 2006 study found that Aboriginal women in Western Australia were more likely than non-Indigenous women to be given hysterectomy for the treatment of mild gynaecological disorders, particularly in rural areas (Spilsbury et al 2006). Peripartum hysterectomy (a high-risk surgery conducted immediately after childbirth) increased between 2010 and 2016 in the US and was more likely to be performed on Black women, with complications resulting from it more frequently in Black-Hispanic-and Asian-American women than in White women (Martin et al 2018;Ryan et al 2018). Racial-minority women of all kinds in the US have also been identified as less likely than White women to receive minimally invasive gynaecological procedures (Ranjit et al 2017).…”