Racial disparity in the clinical determinants and outcomes of cesarean hysterectomy

This study was undertaken to compare the risk factors, indications for and complications rates of cesarean hysterectomy in patient from two different ethnic backgrounds - whites and nonwhites - using patients who had cesarean hysterectomy in the Detroit Medical Center from 1991-2007. During the study period, there were 42 599 cesarean deliveries, making the incidence of cesarean hysterectomy to be 3.7 per 1000 cesarean deliveries. Of the 158 cases, 8.9% were planned, while 91.1% were emergent. Among the emergent cases, nonwhites were more likely to have a higher parity (median [range], 3 [0-13] vs 2 [0-9]; p = .025), while whites were more likely to have a private insurance (64.7% vs 29.1%; p = .001; OR, 4.47; 95% CI, 1.98-10.09]. There were no significant differences in the indications for cesarean hysterectomy among the racial groups. Whites were more likely to have composite cardiopulmonary complications and urological injury compared to nonwhites, (17.6% vs 3.6%; P = .012; OR, 5.68; 95% CI, 1.50-21.51) and (26.5% vs 10.9%; P = .05; OR 2.94; CI, 1.12-7.75), respectively. In conclusion, beyond higher rates of cardiopulmonary complications and urological injury among whites, no significant racial differences exist in the risk factors, indications for, and complications from cesarean hysterectomy.