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Racial disparities in extended venous thromboembolism prophylaxis after hysterectomy
Wenbo Wu1,2, Sherry Wu3,4, Sim Berlene Mariano5,6
1Departments of Population Health and Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Plos One
|January 28, 2025
Summary
Black patients were significantly less likely to receive extended venous thromboembolism prophylaxis (eVTEp) after hysterectomy compared to White patients. Further research is needed to understand the reasons for this disparity in postoperative care.
Area of Science:
- Medical research
- Surgical quality improvement
- Health equity
Background:
- Venous thromboembolism (VTE) is a major cause of death after surgery, necessitating extended VTE prophylaxis (eVTEp).
- Existing literature suggests potential racial disparities in postoperative care.
- Hysterectomy is a common major abdominopelvic surgery where eVTEp is indicated.
Purpose of the Study:
- To investigate racial disparities in the administration of eVTEp following hysterectomy.
- To analyze eVTEp use across different racial groups in a statewide surgical collaborative.
Main Methods:
- Retrospective cohort study of 24,513 post-hysterectomy patients from January 2016 to February 2020.
- Analysis of race (Black/African American vs. White American) as the primary variable of interest.
- Mixed effects logistic regression used for risk adjustment, considering numerous clinical and surgical covariates.
Main Results:
- Black patients were significantly less likely to receive eVTEp than White patients (OR=0.776, P=0.039).
- Factors associated with increased likelihood of eVTEp included tobacco use, coronary artery disease, bleeding disorder, cancer, functional status, and specific surgical approaches.
- 1,107 patients (4.45%) received eVTEp, with 13.24% being Black and 82.53% being White.
Conclusions:
- Black females undergoing hysterectomy were significantly less likely to receive recommended eVTEp compared to White females.
- The observed disparity in eVTEp administration warrants further investigation into socioeconomic factors and potential biases.
- Addressing these disparities is crucial for equitable postoperative VTE prevention.
