247 Racial disparities in the risk of postoperative complications after non-obstetric surgery in pregnancy

Abstract

To determine whether non-Hispanic Black and Latina pregnant women were at higher risk of 30-day postoperative complications after non-obstetric surgery compared with non-Hispanic White pregnant women, and whether this risk persisted among apparently healthy pregnant women. Retrospective analysis of the National Surgical Quality Improvement program from 2005-2012. We included pregnant women 18-51 years without prior surgery in the preceding 30 days who underwent a non-obstetrical operation (i.e., no cesarean delivery, peripartum hysterectomy). Race and ethnicity were categorized as non-Hispanic Black, Latina, and non-Hispanic White (referent group). Those with other race or ethnicity were excluded from the analysis. The outcome was 30-day composite of major postoperative complications. We used modified Poisson regression. Because disparities in outcomes have been attributed to a higher burden of preoperative comorbidities among Black patients, differences in racial outcomes among healthy pregnant women defined as ASA physical status of 1 or 2 were also examined. Among 3,093 pregnant women, 18% were non-Hispanic Black, 20% Latina, and 62% non-Hispanic White. The most common surgical procedures were appendectomy (36%) and cholecystectomy (19%). The frequency of chronic comorbidities (ASA class >2) was higher in Black (18%) compared with Latina (9%) and White women (12%, all p<0.001) (Table 1). Black pregnant women had a higher risk of 30-day major postoperative complications compared with their White peers (9% vs. 6%: adjusted risk ratio, aRR: 1.64, 95% CI: 1.08-2.50 (Table 2). The increased risk of complications persisted among healthy Black pregnant women compared with their healthy White peers (7% vs. 4%; aRR: 1.64, 95% CI: 1.08-2.50). Latina women were not increased risk postoperative complications. Non-Hispanic Black pregnant women were at higher risk of postoperative complications following non-obstetric surgery. The Black-White racial disparity in risk of postoperative complications persisted among healthy pregnant women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)