Racial and ethnic disparities in the surgical management of tubal ectopic pregnancy

OBJECTIVE: To evaluate racial and ethnic disparities in the surgical management of ectopic pregnancy over time. DESIGN: Retrospective cohort study. SETTING: None. PATIENT(S): Surgically-managed cases of patients with tubal ectopic pregnancy within the American College of Surgeons National Surgical Quality Improvement Program database between 2010 and 2019. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Surgical approach (laparoscopic compared with open) and procedure (salpingectomy compared with salpingostomy/other). RESULT(S): Of 7791 patients undergoing surgical management of tubal ectopic pregnancy, 21.8% identified as Hispanic, 24.5% as Black, 9.4% as Asian/other, and 44.3% as White. Use of laparoscopy increased 1.3% per year from 81.4% in 2010 to 91.0% in 2019 (95% confidence interval [CI], 0.010–0.016). Odds of undergoing laparoscopic surgery were lower in Black (adjusted odds ratio [aOR] 0.52; 95% CI, 0.45–0.61) and Hispanic patients (aOR 0.52; 95% CI, 0.44–0.61) compared with White patients and remained similar over time. The use of salpingectomy increased by 1.1% per year from 80.6% in 2010 to 94.7% in 2019 (95% CI, 0.009–0.014). Odds of undergoing salpingectomy were higher among Black (aOR 1.78, 95% CI 1.43-2.23) and Hispanic patients (aOR 1.54; 95% CI, 1.24–1.93) and lower among Asian patients (aOR 0.73, 95% CI, 0.56–0.95) compared with White patients. These ratios remained similar for Black and Asian patients over time. CONCLUSION(S): Despite the increased use of laparoscopy and salpingectomy in the surgical management of ectopic pregnancy over time, Black and Hispanic patients remain less likely to undergo minimally invasive surgery and more likely to undergo salpingectomy compared with White patients.