ABSTRACT
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 42599 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.
Subject(s)
Black or African American/statistics & numerical data , Cesarean Section/adverse effects , Health Status Disparities , Hysterectomy/methods , Adult , Cesarean Section/methods , Cesarean Section/statistics & numerical data , Cohort Studies , Confidence Intervals , Female , Humans , Hysterectomy/statistics & numerical data , Odds Ratio , Parity , Pregnancy , Prejudice , Retrospective Studies , Risk Factors , Social Justice , Treatment Outcome , White People , Women's HealthABSTRACT
PURPOSE: To review the incidence, trends, risk factors, indications for, and complications associated with cesarean hysterectomy (CH) in our institution. MATERIALS AND METHODS: Retrospective study of 158 women who had CH at the Detroit Medical Center during a 17 period. RESULTS: During the study period, 158 of 202,356 deliveries were CH, giving an overall incidence of 0.78 per 1,000 deliveries. Of the 158 cases, 14 were elective while 144 were emergently performed due to complications encountered at cesarean section. Analysis of the eligible 144 cases showed that the commonest risk factors were previous cesarean delivery (76%) and placenta previa (35%). Abnormal placenta adherence was the indication for CH in 50.7%, followed by uterine atony in 34.7% and uterine rupture in 16.7% of the cases. Febrile morbidity (44.4%) and disseminated intravascular coagulopathy (22.9%) were the most common postoperative complications. Most complications occurred in patients with parity greater than two. Compared to the last decade, CH performed more recently were less likely to be complicated by bowel injury or disseminated intravascular coagulopathy. CONCLUSION: Morbidly adherent placenta has replaced uterine atony as the leading indication for emergent CH in our institution. High parity remains a risk factor for complications; however, we recorded a reduction in bowel injury and disseminated intravascular coagulopathy in recent years.