The rate of peripartum hysterectomy (PH) is rising in the United States. Patient characteristics such as race and ethnicity have been identified as a predictor of other adverse perinatal outcomes such as preterm delivery and stillbirth. In order to determine possible predictors and disparities, different clinical and socio-economic characteristics were examined.METHODS:
We conducted a retrospective cohort study of 9,082,034 women (weighted to represent over 43 million women) aged 12–55, who were hospitalized for childbirth using data from the National Inpatient Sample (2004–2014). We tested the association between patient race/ethnicity and receiving PH during the hospitalization, before and after adjustment for advanced age, year of hospitalization, socioeconomic and hospital-level factors, as well as other known clinical correlates of PH.RESULTS:
In adjusted analyses, race/ethnicity remained a significant predictor of in-hospital PH for Black (OR=1.11; P<.05) and Hispanic (OR=1.18; P<.01) women compared to their white counterparts. Compared to women who are insured with an HMO or private insurance, women who are covered by Medicaid (OR 1.13) or are self pay (OR 1.23) were at statistically increased risk. Conversely, economic level, using zip code quartile as an indicator, was not a statistically significant predictor.CONCLUSION:
Race/ethnicity has been found to be an independent predictor of PH, even after adjustment for clinical, socioeconomic and hospital factors. Future research should further investigate the reasons why certain women are at increased risk for receiving this high risk procedure, in order to develop and test interventions to improve peripartum outcomes.