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Am J Perinatol
DOI: 10.1055/a-1974-9507
Original Article

Racial Disparities in Sterilization Procedure Performed at Time of Cesarean Section

Lauren K. Walheim 
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Christopher X. Hong
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
2   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Rebecca F. Hamm
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
3   Leonard Davis Institute of Health Economics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Objectives While bilateral tubal ligation has historically been performed for sterilization at cesarean delivery (CD), recent data supports the use and safety of opportunistic bilateral salpingectomy during CD to decrease lifetime ovarian cancer risk. Prior studies have described racial disparities in sterilization rates, but there is a paucity of data regarding racial disparities in type of sterilization procedure. Our objective was to determine differences in sterilization procedure type performed at CD by race (Black vs. non-Black) to evaluate for equity in bilateral salpingectomy utilization.

Study Design We performed a retrospective cohort study of patients included in the American College of Surgeons National Surgical Quality Improvement Program database who underwent sterilization at time of CD from January 2019, to December 2020, identified using Current Procedural Terminology codes. Patients without documented race were excluded. Multivariable logistic regression was used to determine odds of undergoing bilateral salpingectomy compared with bilateral tubal ligation by race while controlling for confounders.

Results Of 28,147 patients who underwent CD, 3,087 underwent concurrent sterilization procedure, and 2,161 met inclusion criteria (Black: n = 279; non-Black: n = 1,882). Black patients were significantly more likely to have hypertension (10.8% vs. 5.3%, p < 0.01), bleeding disorders (3.9% vs. 1.3%, p < 0.01), preoperative anemia (hemoglobin < 11 g/dL; 36.9% vs. 21.3%, p < 0.01), and be of American Society of Anesthesiologist class 3 or higher (29.4% vs. 22.5%, p = 0.01) than non-Black patients. After adjusting for differences, Black patients were almost 50% less likely than non-Black patients to undergo bilateral salpingectomy compared with bilateral tubal ligation for sterilization at CD (adjusted odds ratio = 0.52, 95% confidence interval: 0.36–0.75).

Conclusion Despite evidence that bilateral salpingectomy decreases ovarian cancer risk and is safe at CD, there is a racial disparity in bilateral salpingectomy utilization. While the cause of this disparity is unclear, further research is warranted to determine root causes and equitable solutions.

Key Points

  • Opportunistic salpingectomy is recommended for primary prevention of ovarian cancer in patients undergoing pelvic surgery who have completed childbearing.

  • Black patients were almost 50% less likely to undergo bilateral salpingectomy compared with bilateral tubal ligation than non-Black patients even after controlling for possible confounders.

  • Further research is needed to determine root cause of the racial disparity in bilateral salpingectomy utilization rate.

Keywords

equity - opportunistic salpingectomy - racial disparities - sterilization - tubal ligation


Publication History

Received: 11 July 2022

Accepted: 01 November 2022

Accepted Manuscript online:
09 November 2022

Article published online:
21 December 2022

© 2022. Thieme. All rights reserved.

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