Complications following hysterectomy in women with intellectual and developmental disabilities

Nili Amir; Monika Mitra; Katherine Leung; Tiffany A Moore Simas

doi:10.1016/j.dhjo.2021.101213

Complications following hysterectomy in women with intellectual and developmental disabilities

Disabil Health J. 2022 Jan;15(1):101213. doi: 10.1016/j.dhjo.2021.101213. Epub 2021 Aug 31.

Authors

Nili Amir¹, Monika Mitra², Katherine Leung³, Tiffany A Moore Simas⁴

Affiliations

¹ UConn Health, Department of Obstetrics and Gynecology, 263 Farmington Avenue Farmington, CT 06030, USA; University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA.
² The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management Brandeis University, 415 South Street Waltham, MA, USA.
³ University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA.
⁴ University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA; UMass Memorial Health Department of Obstetrics and Gynecology Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA, 01605, USA.

PMID: 34531173
DOI: 10.1016/j.dhjo.2021.101213

Abstract

Background: Limited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD).

Objective: The objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy.

Methods: The National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables.

Results: Of eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18-11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10-38.36).

Conclusions: Women with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.

Keywords: Disability; Disparities; Gynecology; Health outcomes; Surgery.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Developmental Disabilities*
Disabled Persons*
Female
Humans
Hysterectomy* / adverse effects
Intellectual Disability*
Middle Aged

Grants and funding

R01 HD082105/HD/NICHD NIH HHS/United States