Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy

Amy L. Alexander, Anna E. Strohl, Stephanie Rieder, Jane Holl, Emma L. Barber*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE:To estimate the associations among race, route of hysterectomy, and postoperative complications among women undergoing hysterectomy for benign indications.METHODS:A cohort study was performed. All patients undergoing hysterectomy for benign indications, recorded in the National Surgical Quality Improvement Program and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression.RESULTS:Of 15,136 women who underwent hysterectomy for benign indications, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs 22.9%; odds ratio [OR] 3.36, 95% CI 3.11-3.64). Black women had larger uteri (median 262 g vs 123 g; 60.7% vs 25.6% with uterus greater than 250 g), more prior pelvic surgery (58.5% vs 53.2%), and higher body mass indices (32.7 vs 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (adjusted OR 2.02, 95% CI 1.85-2.20). Black women experienced more major complications than white women (4.1% vs 2.3%; P<.001) and more minor complications (11.4% vs 6.7%; OR 1.78, P<.001). Again these disparities persisted with adjustment (major adjusted OR 1.56, 95% CI 1.25-1.95; minor adjusted OR 1.27, 95% CI 1.11-1.47).CONCLUSIONS:Black women undergo a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.

Original languageEnglish (US)
Pages (from-to)6-12
Number of pages7
JournalObstetrics and gynecology
Volume133
Issue number1
DOIs
StatePublished - Jan 1 2019

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Hysterectomy
Odds Ratio
Uterus
Quality Improvement
Body Mass Index
Cohort Studies
Logistic Models

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{98335850cf9642089b9d78e3c578d737,
title = "Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy",
abstract = "OBJECTIVE:To estimate the associations among race, route of hysterectomy, and postoperative complications among women undergoing hysterectomy for benign indications.METHODS:A cohort study was performed. All patients undergoing hysterectomy for benign indications, recorded in the National Surgical Quality Improvement Program and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression.RESULTS:Of 15,136 women who underwent hysterectomy for benign indications, 75{\%} were white and 25{\%} were black. Black women were more likely to undergo an open hysterectomy than white women (50.1{\%} vs 22.9{\%}; odds ratio [OR] 3.36, 95{\%} CI 3.11-3.64). Black women had larger uteri (median 262 g vs 123 g; 60.7{\%} vs 25.6{\%} with uterus greater than 250 g), more prior pelvic surgery (58.5{\%} vs 53.2{\%}), and higher body mass indices (32.7 vs 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (adjusted OR 2.02, 95{\%} CI 1.85-2.20). Black women experienced more major complications than white women (4.1{\%} vs 2.3{\%}; P<.001) and more minor complications (11.4{\%} vs 6.7{\%}; OR 1.78, P<.001). Again these disparities persisted with adjustment (major adjusted OR 1.56, 95{\%} CI 1.25-1.95; minor adjusted OR 1.27, 95{\%} CI 1.11-1.47).CONCLUSIONS:Black women undergo a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.",
author = "Alexander, {Amy L.} and Strohl, {Anna E.} and Stephanie Rieder and Jane Holl and Barber, {Emma L.}",
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Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy. / Alexander, Amy L.; Strohl, Anna E.; Rieder, Stephanie; Holl, Jane; Barber, Emma L.

In: Obstetrics and gynecology, Vol. 133, No. 1, 01.01.2019, p. 6-12.

Research output: Contribution to journalArticle

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T1 - Examining Disparities in Route of Surgery and Postoperative Complications in Black Race and Hysterectomy

AU - Alexander, Amy L.

AU - Strohl, Anna E.

AU - Rieder, Stephanie

AU - Holl, Jane

AU - Barber, Emma L.

PY - 2019/1/1

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N2 - OBJECTIVE:To estimate the associations among race, route of hysterectomy, and postoperative complications among women undergoing hysterectomy for benign indications.METHODS:A cohort study was performed. All patients undergoing hysterectomy for benign indications, recorded in the National Surgical Quality Improvement Program and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression.RESULTS:Of 15,136 women who underwent hysterectomy for benign indications, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs 22.9%; odds ratio [OR] 3.36, 95% CI 3.11-3.64). Black women had larger uteri (median 262 g vs 123 g; 60.7% vs 25.6% with uterus greater than 250 g), more prior pelvic surgery (58.5% vs 53.2%), and higher body mass indices (32.7 vs 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (adjusted OR 2.02, 95% CI 1.85-2.20). Black women experienced more major complications than white women (4.1% vs 2.3%; P<.001) and more minor complications (11.4% vs 6.7%; OR 1.78, P<.001). Again these disparities persisted with adjustment (major adjusted OR 1.56, 95% CI 1.25-1.95; minor adjusted OR 1.27, 95% CI 1.11-1.47).CONCLUSIONS:Black women undergo a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.

AB - OBJECTIVE:To estimate the associations among race, route of hysterectomy, and postoperative complications among women undergoing hysterectomy for benign indications.METHODS:A cohort study was performed. All patients undergoing hysterectomy for benign indications, recorded in the National Surgical Quality Improvement Program and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression.RESULTS:Of 15,136 women who underwent hysterectomy for benign indications, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs 22.9%; odds ratio [OR] 3.36, 95% CI 3.11-3.64). Black women had larger uteri (median 262 g vs 123 g; 60.7% vs 25.6% with uterus greater than 250 g), more prior pelvic surgery (58.5% vs 53.2%), and higher body mass indices (32.7 vs 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (adjusted OR 2.02, 95% CI 1.85-2.20). Black women experienced more major complications than white women (4.1% vs 2.3%; P<.001) and more minor complications (11.4% vs 6.7%; OR 1.78, P<.001). Again these disparities persisted with adjustment (major adjusted OR 1.56, 95% CI 1.25-1.95; minor adjusted OR 1.27, 95% CI 1.11-1.47).CONCLUSIONS:Black women undergo a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.

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