The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

Objective To compare perioperative outcomes by patient race/ethnicity. Methods A retrospective cohort study identified 7 331 638 childbirth hospitalizations for women aged 12-55 years in the USA between 2004-2014. Peripartum hysterectomy, in-hospital mortality, perioperative complications, length of stay, and cost of hysterectomy data were analyzed using SAS. Results Among childbirth hospitalizations (52.9% white, 13.5% black, 23.0% Hispanic, 5.2% Asian, and 5.4% other), peripartum hysterectomy occurred in 6619. The incidence of peripartum hysterectomy was 90.3 (95% confidence interval [CI] 87.7-93.0) per 100 000 hospitalizations, and higher for black (111.0, 95% CI 104.5-117.4), Hispanic (104.9, 95% CI 99.1-110.8), and Asian women (119.6, 95% CI 109.1-130.2) compared to whites (75.7, 95% CI 72.8-78.5). After adjustment, Hispanic women had an 18% higher odds of undergoing peripartum hysterectomy (odds ratio [OR] 1.18, 95% CI 1.08-1.29;P=0.004) than white women. Non-white women had a 2-3-fold higher odds of in-hospital mortality (OR(black)2.76, 95% CI 1.44-5.30; OR(Hispanic)1.99, 95% CI 1.04-3.82; OR(Asian+other)2.44, 95% CI 1.11-5.40. Black and Asian/other women were more likely to undergo blood transfusions. Conclusion Women of color have higher rates of peripartum hysterectomy and experience higher rates of poor perioperative outcomes and mortality.