Racial/Ethnic Differences in the Risk of Surgical Complications and Post-hysterectomy Hospitalization Among Women Undergoing Hysterectomy for Benign Conditions.

Abstract Study Objective Evaluate whether 30- and 90-day surgical complication and post-operative hospitalization rates after hysterectomy for benign conditions differ by race/ethnicity and whether differences remain after controlling for patient, hospital, and surgical characteristics. Design Retrospective cohort study using administrative data. The exposure was race/ethnicity. Outcomes included five different surgical complications/categories and post-hysterectomy inpatient hospitalization, all identified through 30 and 90 days following hysterectomy hospital discharge, with the exception of hemorrhage/hematoma, which was only identified through 30 days. To examine the association between race/ethnicity and each outcome, we used logistic regression with clustering of procedures within hospitals, adjusting for patient and hospital characteristics, and surgical approach. Setting Multi-state including Florida and New York. Patients Women ≥18 years who underwent hysterectomy for benign conditions using State Inpatient (SID) and State Ambulatory Surgery Databases (SASD). Interventions Hysterectomy for benign conditions. Measurements and Main Results We included 183,697 women undergoing hysterectomy for benign conditions between 1/2011 and 9/2014. In analysis adjusting for surgery route and other factors, Black race was associated with increased risk of 30-day digestive system complications (multivariable-adjusted odds ratio, aOR, 1.98; 95% confidence interval, CI, 1.78-2.21), surgical site infection (aOR, 1.34; 95% CI, 1.18-1.53), post-hysterectomy hospitalization (aOR, 1.31, 95% CI, 1.22-1.40), and urologic complications (aOR, 1.16, 95% CI, 1.01-1.34) compared to White race. Asian/Pacific Islander race was associated with increased risk of 30-day urologic complications (aOR, 1.48, 95% CI, 1.08-2.03), intra-operative injury to abdominal/pelvic organs (aOR, 1.46; 95% CI, 1.23-1.75), and hemorrhage/hematoma (aOR, 1.33, 95% CI, 1.06-1.67) compared to White race. Hispanic ethnicity was associated with increased risk of 30-day post-hysterectomy hospitalization (aOR, 1.11, 95% CI, 1.02-1.20) compared to White race. All findings were similar at 90 days. Conclusion Black and Asian/Pacific Islander women had higher risk of some 30- and 90-day surgical complications after hysterectomy than White women. Black and Hispanic women had higher risk of post-hysterectomy hospitalization. Intervention strategies aimed at identifying and better managing disparities in pre-existing conditions/comorbidities could reduce racial/ethnic differences in outcomes.