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Am J Perinatol 2021; 38(10): 999-1009
DOI: 10.1055/s-0041-1729879
SMFM Fellowship Series Article

Racial and Ethnic Disparities in Peripartum Hysterectomy Risk and Outcomes

Margaret H. Bogardus
1   Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Timothy Wen
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Cynthia Gyamfi-Bannerman
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Jason D. Wright
3   Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Dena Goffman
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Jean-Ju Sheen
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Mary E. D'Alton
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Alexander M. Friedman
2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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Funding This research was supported by the Health Resources and Services Administration Maternal and Child Health Bureau (R40 MC3287901).
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Abstract

Objective This study aimed to determine whether race and ethnicity contribute to risks associated with peripartum hysterectomy.

Study Design This retrospective cross-sectional study utilized the 2000–2014 Nationwide Inpatient Sample to analyze risk of peripartum hysterectomy and associated severe maternal morbidity, mortality, surgical injury, reoperation, surgical-site complications, and mortality by maternal race and ethnicity. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, other, and unknown. Multivariable log-linear regression models including patient, clinical, and hospital risk factors were performed with adjusted risk ratios (aRRs) and 95% confidence intervals (CIs).

Results Of 59,854,731 delivery hospitalizations, there were 45,369 peripartum hysterectomies (7.6 per thousand). Of these, 37.8% occurred among non-Hispanic white, 13.9% among non-Hispanic black, and 22.8% among Hispanic women. In adjusted analyses, non-Hispanic black (aRR: 1.21, 95% CI: 1.17–1.29) and Hispanic women (aRR: 1.25, 95% CI: 1.22–1.29) were at increased risk of hysterectomy compared with non-Hispanic white women. Risk for severe morbidity was increased for non-Hispanic black (aRR: 1.25, 95% CI: 1.19–1.33), but not for Hispanic (aRR: 1.02, 95% CI: 0.97–1.07) women. Between these three groups, risk for intraoperative complications was highest among non-Hispanic white women, risk for reoperation was highest among Hispanic women, and risk for surgical-site complications was highest among non-Hispanic black women. Evaluating maternal mortality, non-Hispanic black women (RR: 3.83, 95% CI: 2.65–5.53) and Hispanic women (RR: 2.49, 95% CI: 1.74–3.59) were at higher risk than non-Hispanic white women.

Conclusion Peripartum hysterectomy and related complications other than death differed modestly by race. In comparison, mortality differentials were large supporting that differential risk for death in the setting of this high-risk scenario may be an important cause of disparities.

Key Points

  • Peripartum hysterectomy and related complications differed modestly by race.

  • Mortality differentials in the setting of peripartum hysterectomy were large.

  • Failure to rescue may be an important cause of peripartum hysterectomy disparities.

Keywords

peripartum hysterectomy - maternal disparities - obstetric safety - maternal morbidity

Note

This work was presented at the 2020 Society for Maternal Fetal Medicine Annual Meeting in Grapevine, TX, February 3–8, 2020.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. Juli 2020

Angenommen: 05. März 2021

Artikel online veröffentlicht:
27. Mai 2021

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