(230) Racial and Ethnic Disparities in Cesarean Complication Rates using NSQIP Database

Objective: This study aims to examine the relationship between patient race and ethnicity and complication rates in cesarean sections while controlling for general surgical risk using the National Surgical Quality Improvement Program (NSQIP) database from the American College of Surgeons (ACS).

Study Design: Women ages 18 and older with a CPT code for cesarean delivery recorded in 2019-2022 in the NSQIP database were included in the analysis. The primary variables were self-reported race and ethnicity. Outcomes of interest were surgical complications reported in the NSQIP database. The association between race (and separately for ethnicity) and complications was assessed using linear regression with robust standard errors for continuous outcomes and modified Poisson regression for binary outcomes. Models were adjusted for age, body mass index, diabetes, hypertension requiring medication, American Society of Anesthesiologist physical status (ASAPS) class, chronic steroid use, and current smoker within one year.

Results: Among 56,635 patients in the study cohort, the average age was 30.8 (standard deviation of 5.6). Race was significantly associated with all outcomes considered. After controlling for covariates, the major complication rate was significantly higher among all race groups compared to White, and unknown group had a significantly lower major complication rate. Black patients had 43% higher risk of a major complication compared to White patients (95% CI = 1.28, 1.59). Hispanic patients had a 20% higher risk of major complications compared to non-Hispanic patients (95% CI = 1.09, 1.33). Patients with unknown or unreported race had 45% higher risk of a minor complication compared to White patients (95% CI = 1.33, 1.59). There was a notable amount of concurrence between unknown race and unknown ethnicity.

Conclusion: Self-identified race is associated with significantly higher rates of surgical complications following cesarean delivery even after controlling for surgical risk factors. More comprehensive obstetrics data is needed to measure and improve maternal morbidity and mortality nationwide.