Invasive Surgery for Tubal Ectopic Pregnancy More Common in Women of Color

Over the past decade, Black and Hispanic patients were consistently more likely to receive invasive surgical procedures to manage a tubal ectopic pregnancy than white patients, according to a retrospective cohort study.

In fact, from 2010 to 2019, these women of color were nearly twice as likely to receive open surgery for a tubal ectopic pregnancy, reported Alexandra Huttler, MD, of the University of Pennsylvania in Philadelphia:

• Black women (adjusted odds ratio [aOR] 1.91, 95% CI 1.63-2.24)
• Hispanic women (aOR 1.93, 95% CI 1.64-2.28)

Additionally, Black women were 78% (aOR 1.78, 95% CI 1.43-2.23) more likely to undergo salpingectomy — total removal of the fallopian tube — compared with white women, while Hispanic women were 54% (aOR 1.54, 95% CI 1.24-1.93) more likely, Huttler said in a presentation at the virtual American Society for Reproductive Medicine annual meeting.

“Our results suggest that surgical management of tubal ectopic pregnancy has changed in the past decade, with greater utilization of laparoscopy and increased rates of salpingectomy,” Huttler said, adding that the majority of these disparities persisted over the last 10 years, despite advancements and changes in utilization of laparoscopic procedures.

“Calling attention to these disparities is the first step to establishing programming that can be directed towards reducing these biases, in an attempt to equalize medical care across all racial and ethnic groups,” she said.

Huttler and colleagues analyzed data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP), and included patients, ages 18 to 50, who underwent a surgical procedure to manage their ectopic pregnancy between 2010 and 2019.

In analyses of both surgical approach and type of procedure, the researchers adjusted for variables including an American Society of Anesthesiology (ASA) score of 3 or more, BMI, age, emergency status, age, smoking status, and preexisting conditions.

Huttler’s group analyzed 7,791 patients that received surgical management of a tubal ectopic pregnancy during the study time period. Approximately 25% of patients were Black, 22% were Hispanic, 9% were Asian, and nearly half were white.

Around 86% of patients underwent a laparoscopic procedure, and 14% had open surgery. Patients in the open-surgery group had a higher BMI, an ASA score of 3 or more, or a transfusion before surgery. These patients were also more likely to be an emergency case.

The proportion of laparoscopic procedures increased from 81% in 2010 to 91% in 2019. Compared to white patients, there was a lower likelihood of laparoscopic surgery among both Black (aOR 0.52, 95% CI 0.45-0.61) and Hispanic women (aOR 0.52, 95% CI 0.44-0.61). There were no changes in the relationship between surgical approach and patient race/ethnicity across the study time period.

In an analysis of procedure type, Huttler’s group found that the majority of patients had a salpingectomy, with just 9% undergoing a salpingostomy. The salpingectomy cohort had a higher proportion of patients with obesity, an ASA score of 3 or more, and transfusion before surgery.

Salpingectomy procedures increased from 81% in 2019 to nearly 95% in 2019. Asian women were less likely to receive a salpingectomy than white women (aOR 0.73, 95% CI 0.56-0.95).

Hispanic women had increased odds of salpingectomy from 2010 to 2014, but that disparity dissipated between 2015 and 2019.

Huttler noted that the study was limited by its retrospective design and its reliance on procedural coding to account for surgical variation. Additionally, Huttler stated that the use of national data did not allow researchers to adjust for certain confounding variables, including gestational age at presentation and patients’ socioeconomic status.