Assessing the impact of racial and ethnic disparities on 30-day emergency department visits after hysterectomy: A state-based retrospective cohort study

Christelle Xiong; Yiheng Wang; Chen Dun; Mostafa A Borahay; Hadi Kharrazi

doi:10.1002/ijgo.70950

Assessing the impact of racial and ethnic disparities on 30-day emergency department visits after hysterectomy: A state-based retrospective cohort study

Int J Gynaecol Obstet. 2026 Mar 13. doi: 10.1002/ijgo.70950. Online ahead of print.

Authors

Christelle Xiong¹, Yiheng Wang¹, Chen Dun^{1

2}, Mostafa A Borahay³, Hadi Kharrazi^{1

4}

Affiliations

¹ Division of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
² Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
³ Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.

PMID: 41822943
DOI: 10.1002/ijgo.70950

Abstract

Objective: The purpose of this study was to assess the impact of racial/ethnic disparities and other variables in 30-day Emergency Department (ED) visits due to post-hysterectomy complications.

Methods: We conducted a retrospective cohort study of patients who underwent hysterectomy between 2017 and 2021 in Florida and Maryland using Healthcare Cost and Utilization Project (HCUP) databases. Multivariable logistic regression models estimated associations between race/ethnicity and 30-day ED visits, including interaction terms for state, surgery route, and setting. Generalized linear modeling was used to assess surgery costs.

Results: Black patients had significantly higher odds of 30-day ED visits compared to White patients (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.12-1.20, P < 0.001), while Asian or Pacific Islander patients had lower odds (OR 0.86, CI: 0.76-0.98, P = 0.020). Racial disparities differed by state. For example, the increased risk of 30-day ED visits among Hispanic patients was attenuated in Maryland compared to Florida (OR 0.85, CI: 0.73-0.98, P = 0.024). Black patients had consistently higher odds in both inpatient and outpatient settings, whereas elevated risk among Hispanic patients was limited to outpatient procedures. Racial compositions also varied by primary payer group. Total charges for index hysterectomy and 30-day ED utilization were lower in Maryland compared to Florida (OR 0.21, CI: 0.21-0.21, P < 0.001).

Conclusion: Significant racial disparities in 30-day ED visits persist following hysterectomy. These disparities are associated with geographic, clinical, and socioeconomic factors. These findings highlight the necessity for interventions focused on promoting health equity.

Keywords: emergency department; gynecologic surgery; healthcare utilization; hysterectomy; postoperative complications; racial disparities; retrospective studies.