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Published on: January 17, 2019
Incidence and Outcomes of Surgically Managed Ectopic Pregnancy in Women With Disabilities: A Population-Based
Natalie V Scime1,2, Beili Huang1, Hilary K Brown3,4
1Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Background:
Disparities in the incidence, management, and outcomes of ectopic pregnancy have been documented among marginalised patients; however, there are few data on ectopic pregnancy in women with disabilities.
Objective:
To compare the incidence and outcomes of surgically managed ectopic pregnancy in women with and without disability.
Methods:
We conducted a population-based cross-sectional study using the National Inpatient Sample of discharges from US community hospitals (January 2016-December 2021). We analysed 9769 hospitalisations for surgically managed ectopic pregnancy among females aged 15-44 years. Disability was measured using a published administrative data diagnosis code algorithm. Outcomes were the incidence rate of ectopic pregnancy, surgical management approach (route, tubal removal versus sparing), complications (length of stay [LOS] ≥ 3 days, blood transfusion), and use of more extensive procedures than are standard (hysterectomy, oophorectomy, bilateral salpingectomy, tubal ligation). Weighted analyses were used to generate unadjusted incidence rate ratios (IRR) and outcome risk ratios (RR) from modified Poisson regression adjusted for year of surgery, socio-demographics, smoking, and comorbidities.
Results:
The rate of surgically managed ectopic pregnancy was 2.8 per 1000 obstetric deliveries in disabled females and 2.3 per 1000 in non-disabled females (IRR 1.26, 95% CI 1.08, 1.45). Compared to non-disabled females, disabled females more often experienced prolonged LOS (adjusted RR 1.34, 95% CI 1.03, 1.74) and use of extensive procedures (adjusted RR 1.49, 95% CI 1.11, 2.00), including hysterectomy (adjusted RR 1.75, 95% CI 0.91, 3.36), oophorectomy (adjusted RR 1.43, 95% CI 0.96, 2.13), and bilateral salpingectomy (adjusted RR 1.30, 95% CI 0.71, 2.37); however, some estimates were imprecise due to low cell counts.
Conclusions:
Disabled women faced slightly higher rates of surgically managed ectopic pregnancy and use of more extensive surgical procedures, including sterilisation. Targeted patient education on ectopic pregnancy and equity-focused guidance for surgeons may be beneficial.
