Black, Hispanic women more likely to undergo invasive procedures for ectopic pregnancies

Compared with white women, Black and Hispanic women with tubal ectopic pregnancies were more likely to undergo invasive procedures, like open surgery rather than laparoscopy, researchers reported at the ASRM Scientific Congress & Expo.

“Previous analyses have identified that Black women are not only more likely to experience an ectopic pregnancy, but are up to 6.8 times as likely to experience ectopic pregnancy-related mortality compared to their white peers,” study author Alexandra G. Huttler, MD, a third-year OB/GYN resident at Pennsylvania Hospital in Philadelphia, said during the presentation.

Also, Huttler said, Black and Hispanic women consistently have been found to be less likely to undergo minimally invasive surgery compared with white women, including disparities identified in tubal ectopic pregnancy management. 

The researchers identified 9,164 patients who had surgery for tubal ectopic pregnancy from 2010 to 2014 and from 2015 to 2019 in the American College of Surgeons’ National Surgical Quality Improvement Program database, differentiating between laparoscopic and open surgical approaches and between salpingectomy and salpingostomy procedures by self-reported race and ethnicity.

The participants included 7,856 (85.7%) women who had laparoscopy and 1,308 (14.3%) who had open surgery. Also, 8,266 (90.2%) had salpingectomy, and 898 (9.8%) had salpingostomy.

The proportion of women who underwent laparoscopic surgery increased from 80.6% in 2010 to 90.8% in 2019 (P < .001), and from 81.3% in 2010 to 94.2% in 2019 among those who underwent salpingectomy (P < .001).

Compared with white patients, Black and Hispanic patients were more likely to have open surgery (adjusted OR = 1.91; 95% CI, 1.63-2.24 for Black patients and aOR = 1.93; 95% CI, 1.64-2.28 for Hispanic patients) after adjusting for American Society of Anesthesiologists (ASA) class, emergent status and blood transfusion prior to surgery.

Also, Black and Hispanic patients were more likely overall to have salpingectomy than white patients (aOR = 1.78; 95% CI, 1.43-2.23 for Black patients and aOR = 1.54; 95% CI, 1.24-1.93 for Hispanic patients) after adjusting for age, BMI, ASA class and blood transfusion prior to surgery.

But specifically, while Hispanic patients were more likely to undergo salpingectomy than white patients in 2010-2014, they were not more likely to do so in 2015-2019 (P = .044), Huttler noted, with a significant decrease in likelihood over time.

Asian patients were less likely to have a salpingectomy (aOR = 0.73; 95% CI, 0.56-0.95).

Further, the researchers found no significant difference between patient race or ethnicity and surgical approach (laproscopic vs. open surgery) between the 2010-2014 and the 2015-2019 cohorts, nor was there a significant difference in the relationship between patient race and ethnicity and surgical procedure (salpingectomy vs. salpingostomy ) between the 2010-2014 and 2015-2019 cohorts in Black and Asian patients.

The researchers concluded that Black and Hispanic women are more likely to have open surgery than a laparoscopy and a salpingectomy than a salpingostomy during surgical management of tubal ectopic pregnancy compared with white women, with most of these disparities persisting since 2010 despite the increase in laparoscopy during that time.

“Calling attention to these disparities is the first step in establishing programming that can be directed toward reducing these biases and attempt to equalize medical care across all races and ethnicity,” Huttler said.