Design: Retrospective cohort study

Setting: Michigan Surgical Quality Collaborative

Patients or Participants: Black and White patients undergoing hysterectomy from January 2015 to December 2018

Interventions: Hysterectomy for benign indications

Measurements and Main Results: A total of 20,075 patients underwent hysterectomy during the study period, of whom 3,468 (17.3%) identified as Black and 16,607 (82.7%) identified as White. The groups differed across multiple factors including BMI, ASA class, preoperative anemia, surgical indication, and uterine weight. With regards to perioperative factors, Black patients were less likely to undergo surgery via minimally invasive approach across every uterine weight category, less to likely to have surgery with a high-volume surgeon, had higher estimated blood loss, greater utilization of hemostatic agents, and longer operative time. However, Black patients were more likely to receive an appropriate preoperative work up, appropriate abdominal prep, VTE prophylaxis, preferred preoperative antibiotics, and intraoperative warming. Black patients were more likely to have any major postoperative complication (8.7% vs 4.0%, p<.001), which included deep/organ space surgical site infection, sepsis, blood transfusion, VTE, cardiovascular complication, pneumonia, and readmission. After adjusting for morbid obesity, ASA class, preoperative anemia, uterine weight, operative time, minimally invasive approach, surgeon volume, insurance type, teaching hospital status, preoperative antibiotics, and use of hemostatic agents in multivariable logistic regression, Black patients were more likely to experience a major postoperative complication (aOR 1.35, 95%CI 1.13-1.6, P<.001) compared to their White peers.

Conclusion: Racial disparities in postoperative complication rates persist even after accounting for known clinical risk factors and perioperative quality consensus guidelines. Potentially modifiable factors that may help to reduce disparities in postoperative complications include maximizing utilization of minimally invasive surgical approach, referral to high volume gynecologic surgeons, correcting preoperative anemia, and minimizing use of hemostatic agents.