Differences in Surgery Classification and Indications for Peripartum Hysterectomy at a Major Academic Institution

Author:

Meeks Monica1,Voegtline Kristin2,Vaught Arthur J.3,Lawson Shari M.3ORCID

Affiliation:

1. Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland

2. Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland

3. Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland

Abstract

Objective Peripartum hysterectomy is associated with increased morbidity and mortality relative to elective gynecologic hysterectomy and its incidence has grown with the rising cesarean delivery rate. We sought to understand indications and perioperative outcomes for peripartum hysterectomy at our academic institution and to evaluate differences among racial/ethnic groups. Study Design We performed a retrospective chart review of women at a tertiary care center who underwent delivery of a newborn and had a peripartum hysterectomy during the same admission between 2008 and 2018. Demographic, clinical, and socioeconomic characteristics of patients were compared with respect to patient's race/ethnic group. Results A total of 112 hysterectomies were included in our study. White women undergoing peripartum hysterectomy were more likely to have had an elective/anticipated peripartum hysterectomy (vs. a nonelective/emergent peripartum hysterectomy) than Black women. There were racial differences detected in the indication for peripartum hysterectomy; White women were more likely to have abnormal placentation (75 vs. 54% in Black women, p = 0.036), whereas Black women were more likely to present with postpartum hemorrhage (27 vs. 2%, p = 0.002). Black women were also more likely to undergo reoperation after peripartum hysterectomy (15 vs. 2% in White women, p = 0.048). There were no differences in any other perioperative outcomes including blood transfusion, accidental laceration, and 30-day readmission. Conclusion Differences exist among elective versus nonelective peripartum hysterectomy by race/ethnicity and in indications for peripartum hysterectomy by race/ethnicity. Further investigation should be performed to determine whether the differences identified are due to disparate management of atony/postpartum hemorrhage or inequitable referral patterns for suspected abnormal placentation by race/ethnicity. Key Points

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

Reference15 articles.

1. Risk of peripartum hysterectomy and center hysterectomy and delivery volume;S Govindappagari;Obstet Gynecol,2016

2. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations;A M Friedman;Am J Obstet Gynecol,2016

3. The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications;S M Lawson;Int J Gynaecol Obstet,2020

4. Obstetrical hysterectomy, cesarean delivery and abnormal placentation;V Dandolu;J Matern Fetal Neonatal Med,2012

5. Indications for and outcomes of emergency peripartum hysterectomy. A five-year review;S Bakshi;J Reprod Med,2000

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