Association of Patient Race With Type of Pelvic Organ Prolapse Surgery Performed and Adverse Events

Abstract

Objectives This study aimed to determine if there are differences in (1) surgical procedures performed for pelvic organ prolapse (POP) and (2) rates of adverse events between racial groups. Methods We conducted a retrospective cohort study of women 18 years and older who underwent POP surgery using the 2005–2015 American College of Surgeons National Surgical Quality Improvement Program database. Race was categorized as Black, White, Hispanic, and other minority. Pelvic organ prolapse procedures were organized into 4 groups: (1) hysterectomy without concurrent POP procedures, (2) vaginal wall repair(s) only without apical suspension, (3) apical suspension with or without vaginal wall repair(s), and (4) obliterative procedures. Patient characteristics and rates of adverse events were noted. A multivariable logistic regression model was used to assess the association between patient race and surgical procedures performed for POP. Results We identified 48,005 women who met the inclusion criteria. Most women who underwent POP surgery were White (79.6% [n = 38,191]). Although only contributing to 4.7% (2,299) of the cohort, Black women experienced higher complication rates compared with White women (10.7% [246] for Black vs 8.9% [3,417] for White women, P < 0.01). Hispanic and other minority women were less likely to undergo an apical suspension than White women (adjusted odds ratios [aORs], 0.79 [0.75–0.84] for Hispanic women and 0.78 [0.71–0.86] for other minority women; P < 0.001 for both). Obliterative procedures were more likely to be performed in Black, in Hispanic, and especially in other minority women (aORs, 1.53 [1.20–1.92] for Black, 1.33 [1.12–1.58] for Hispanic, and 3.67 [3.04–4.42] for other minority women; P < 0.001 for all). Conclusions Racial differences exist among women who undergo POP surgery.

Underrepresentation of Racial and Ethnic Diversity in Research Informing the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Stress Urinary Incontinence Guideline

“…One-third of all Hispanics in the US are monolingual Spanish speakers and 57% are older Hispanic women, who are at high risk for SUI and are likely not represented in the SUI literature reviewed, 19 We previously identified Latina and non-Hispanic women as being more likely than Black and Asian women to undergo a sling surgery when analyzing Medicare claims, yet these women remain underrepresented in clinical outcome studies. 8 Prior 22 They discovered that apical suspension procedures are less often performed for Hispanic women, and Black women and other minority women are more likely to undergo an obliterative procedure for treatment of their high grade prolapse. 22 Although our article highlights an important topic that can be easily overlooked, it is not a comprehensive review of all published SUI clinical studies as we only reviewed the cited studies used to develop the AUA/SUFU SUI guideline.…”

“…8 Prior 22 They discovered that apical suspension procedures are less often performed for Hispanic women, and Black women and other minority women are more likely to undergo an obliterative procedure for treatment of their high grade prolapse. 22 Although our article highlights an important topic that can be easily overlooked, it is not a comprehensive review of all published SUI clinical studies as we only reviewed the cited studies used to develop the AUA/SUFU SUI guideline. Another limitation of this study is our analysis of multicenter data, as studies did not report the specific proportion of patients recruited by individual sites and we did not contact authors for this information.…”

Health Care Disparities in Surgical Management of Pelvic Organ Prolapse: A Contemporary Nationwide Analysis

“…Similarly, the following characteristics were associated with undergoing obliterative rather than reconstructive repair: (1) Black, Hispanic, and other non-White races; (2) uninsured or having Medicaid; (3) seeking care in the midwest regions; (4) belonging to lower income quantiles; and (5) seeking care in rural hospitals. Socioeconomic and racial disparities in access to care of POP have been well documented in recent studies 3,4,6,17 . The primary aim of this study was to hone in on disparities in access to different routes of surgery for POP (sacrocolpopexy versus NTR and access to reconstructive surgery versus obliterative surgery).…”

“…Socioeconomic and racial disparities in access to care of POP have been well documented in recent studies. 3,4,6,17 The primary aim of this study was to hone in on disparities in access to different routes of surgery for POP (sacrocolpopexy versus NTR and access to reconstructive surgery versus obliterative surgery). Studies have consistently shown that SCP provides a more durable POP repair over time compared with NTR.…”

Predictors of prolonged admission after outpatient female pelvic reconstructive surgery

“…The association of Caucasian race with prolonged postoperative LOS must also be investigated further. Previous studies have examined the relationship between race and surgical outcomes and have revealed an increased likelihood of postoperative complications for minority women undergoing POP repair, colpopexy and MUS 30–33 . As such, it has been shown that women undergoing FPRS are vulnerable to health disparities.…”