PDF herunterladen
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
› Institutsangaben Funding This research was supported by the Health Resources and Services Administration Maternal and Child Health Bureau (R40 MC3287901).
› Weitere Informationen
    Lizenzen und Reprints

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

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 ACOG Committee Opinion No. ACOG Committee Opinion No. 649: racial and ethnic disparities in obstetrics and gynecology. Obstet Gynecol 2015; 126 (06) e130-e134
    CrossrefPubMedGoogle Scholar
  • 2 Louis JM, Menard MK, Gee RE. Racial and ethnic disparities in maternal morbidity and mortality. Obstet Gynecol 2015; 125 (03) 690-694
    CrossrefPubMedGoogle Scholar
  • 3 Grobman WA, Bailit JL, Rice MM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol 2015; 125 (06) 1460-1467
    CrossrefPubMedGoogle Scholar
  • 4 Leonard SA, Main EK, Scott KA, Profit J, Carmichael SL. Racial and ethnic disparities in severe maternal morbidity prevalence and trends. Ann Epidemiol 2019; 33: 30-36
    CrossrefPubMedGoogle Scholar
  • 5 Creanga AA, Bateman BT, Kuklina EV, Callaghan WM. Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010. Am J Obstet Gynecol 2014; 210 (05) 435.e1-435.e8
    CrossrefPubMedGoogle Scholar
  • 6 Admon LK, Winkelman TNA, Zivin K, Terplan M, Mhyre JM, Dalton VK. Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012-2015. Obstet Gynecol 2018; 132 (05) 1158-1166
    CrossrefPubMedGoogle Scholar
  • 7 Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 2010; 202 (04) 335-343
    CrossrefPubMedGoogle Scholar
  • 8 Shahul S, Tung A, Minhaj M. et al. Racial disparities in comorbidities, complications, and maternal and fetal outcomes in women with preeclampsia/eclampsia. Hypertens Pregnancy 2015; 34 (04) 506-515
    CrossrefPubMedGoogle Scholar
  • 9 Aziz A, Gyamfi-Bannerman C, Siddiq Z. et al. Maternal outcomes by race during postpartum readmissions. Am J Obstet Gynecol 2019; 220 (05) 484.e1-484.e10
    CrossrefPubMedGoogle Scholar
  • 10 Gyamfi-Bannerman C, Srinivas SK, Wright JD. et al. Postpartum hemorrhage outcomes and race. Am J Obstet Gynecol 2018; 219 (02) 185.e1-185.e10
    CrossrefPubMedGoogle Scholar
  • 11 Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. Updated June 4, 2019. Accessed July 16, 2019 at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm#
    Google Scholar
  • 12 Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993-2006. Obstet Gynecol 2012; 120 (2, Pt 1): 261-268
    CrossrefPubMedGoogle Scholar
  • 13 Howell EA, Brown H, Brumley J. et al. Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle. J Obstet Gynecol Neonatal Nurs 2018; 47 (03) 275-289
    CrossrefPubMedGoogle Scholar
  • 14 Howell EA, Zeitlin J, Hebert PL, Balbierz A, Egorova N. Association between hospital-level obstetric quality indicators and maternal and neonatal morbidity. JAMA 2014; 312 (15) 1531-1541
    CrossrefPubMedGoogle Scholar
  • 15 Zelop CM, Harlow BL, Frigoletto Jr FD, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. Am J Obstet Gynecol 1993; 168 (05) 1443-1448
    CrossrefPubMedGoogle Scholar
  • 16 Yucel O, Ozdemir I, Yucel N, Somunkiran A. Emergency peripartum hysterectomy: a 9-year review. Arch Gynecol Obstet 2006; 274 (02) 84-87
    CrossrefPubMedGoogle Scholar
  • 17 Knight M. UKOSS. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 2007; 114 (11) 1380-1387
    CrossrefPubMedGoogle Scholar
  • 18 Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD. Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 2009; 200 (06) 632.e1-632.e6
    CrossrefPubMedGoogle Scholar
  • 19 Kwee A, Bots ML, Visser GH, Bruinse HW. Emergency peripartum hysterectomy: a prospective study in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2006; 124 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 20 Castaneda S, Karrison T, Cibils LA. Peripartum hysterectomy. J Perinat Med 2000; 28 (06) 472-481
    CrossrefPubMedGoogle Scholar
  • 21 Engelsen IB, Albrechtsen S, Iversen OE. Peripartum hysterectomy-incidence and maternal morbidity. Acta Obstet Gynecol Scand 2001; 80 (05) 409-412
    CrossrefPubMedGoogle Scholar
  • 22 Whiteman MK, Kuklina E, Hillis SD. et al. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 2006; 108 (06) 1486-1492
    CrossrefPubMedGoogle Scholar
  • 23 Ibrahim M, Ziegler C, Klam SL, Wieczorek P, Abenhaim HA. Incidence, indications, and predictors of adverse outcomes of postpartum hysterectomies: 20-year experience in a tertiary care centre. J Obstet Gynaecol Can 2014; 36 (01) 14-20
    CrossrefPubMedGoogle Scholar
  • 24 Stivanello E, Knight M, Dallolio L, Frammartino B, Rizzo N, Fantini MP. Peripartum hysterectomy and cesarean delivery: a population-based study. Acta Obstet Gynecol Scand 2010; 89 (03) 321-327
    CrossrefPubMedGoogle Scholar
  • 25 Spiliopoulos M, Kareti A, Jain NJ, Kruse LK, Hanlon A, Dandolu V. Risk of peripartum hysterectomy by mode of delivery and prior obstetric history: data from a population-based study. Arch Gynecol Obstet 2011; 283 (06) 1261-1268
    CrossrefPubMedGoogle Scholar
  • 26 Eller AG, Bennett MA, Sharshiner M. et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 117 (2, Pt 1): 331-337
    CrossrefPubMedGoogle Scholar
  • 27 Silver RM, Fox KA, Barton JR. et al. Center of excellence for placenta accreta. Am J Obstet Gynecol 2015; 212 (05) 561-568
    CrossrefPubMedGoogle Scholar
  • 28 Silver RM. Foreword: management of abnormal placentation. Clin Obstet Gynecol 2018; 61 (04) 731-732
    CrossrefPubMedGoogle Scholar
  • 29 Wright JD, Devine P, Shah M. et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 2010; 115 (06) 1187-1193
    CrossrefPubMedGoogle Scholar
  • 30 Klebanoff MA, Snowden JM. Historical (retrospective) cohort studies and other epidemiologic study designs in perinatal research. Am J Obstet Gynecol 2018; 219 (05) 447-450
    CrossrefPubMedGoogle Scholar
  • 31 Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010; 203 (06) 558.e1-558.e7
    CrossrefPubMedGoogle Scholar
  • 32 Kuklina EV, Whiteman MK, Hillis SD. et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
    CrossrefPubMedGoogle Scholar
  • 33 Kilpatrick SK, Ecker JL. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016; 215 (03) B17-B22
    CrossrefPubMedGoogle Scholar
  • 34 Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM. Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol 2006; 194 (04) 992-1001
    CrossrefPubMedGoogle Scholar
  • 35 Romano PS, Yasmeen S, Schembri ME, Keyzer JM, Gilbert WM. Coding of perineal lacerations and other complications of obstetric care in hospital discharge data. Obstet Gynecol 2005; 106 (04) 717-725
    CrossrefPubMedGoogle Scholar
  • 36 Goff SL, Pekow PS, Markenson G, Knee A, Chasan-Taber L, Lindenauer PK. Validity of using ICD-9-CM codes to identify selected categories of obstetric complications, procedures and co-morbidities. Paediatr Perinat Epidemiol 2012; 26 (05) 421-429
    CrossrefPubMedGoogle Scholar
  • 37 Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg 2010; 211 (03) 325-330
    CrossrefPubMedGoogle Scholar
  • 38 Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care 2011; 49 (12) 1076-1081
    CrossrefPubMedGoogle Scholar
  • 39 Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009; 361 (14) 1368-1375
    CrossrefPubMedGoogle Scholar
  • 40 Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 2009; 250 (06) 1029-1034
    CrossrefPubMedGoogle Scholar
  • 41 Patient Safety Net, the Agency for Healthcare Research and Quality. Failure to rescue. Accessed May 10, 2020 at: https://psnet.ahrq.gov/primer/failure-rescue
    Google Scholar
  • 42 Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130 (02) 366-373
    CrossrefPubMedGoogle Scholar
  • 43 Clark SL, Hankins GD. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol 2012; 119 (2, Pt 1): 360-364
    CrossrefPubMedGoogle Scholar
  • 44 Wright JD, Herzog TJ, Shah M. et al. Regionalization of care for obstetric hemorrhage and its effect on maternal mortality. Obstet Gynecol 2010; 115 (06) 1194-1200
    CrossrefPubMedGoogle Scholar
  • 45 Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta accreta spectrum. Am J Obstet Gynecol 2018; 219 (06) B2-B16
    CrossrefPubMedGoogle Scholar
  • 46 Petersen EE, Davis NL, Goodman D. et al. Racial/Ethnic Disparities in pregnancy-related deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep 2019; 68 (35) 762-765
    CrossrefPubMedGoogle Scholar