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Nicola-Ducey L, Nolan O, Cichowski S, Osmundsen B. Racial and Ethnic Disparities in Sacrocolpopexy Approach. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00252. [PMID: 38990736 DOI: 10.1097/spv.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
IMPORTANCE Racial inequity elevates risk for certain diagnoses and health disparities. Current data show disparities for Black women when comparing open versus minimally invasive hysterectomy. It is unknown if a similar disparity exists in surgical management of pelvic organ prolapse. OBJECTIVE The objective of this study was to determine whether racial or ethnic disparities exist for open abdominal versus minimally invasive sacrocolpopexy. STUDY DESIGN Cross-sectional data of the Healthcare Cost and Utilization Project National Inpatient Sample and the Nationwide Ambulatory Surgery Sample for the year 2019 was used. Bivariate analysis identified demographic and perioperative differences between abdominal versus minimally invasive sacrocolpopexy, which were compared in a multivariable logistic regression. RESULTS Forty-one thousand eight hundred thirty-seven patients underwent sacrocolpopexy: 35,820 (85.6%), minimally invasive sacrocolpopexy, and 6,016, (14.4%) abdominal sacrocolpopexy. In an unadjusted analysis, Black patients were more likely to undergo an abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 2.14, 95% CI 1.16-3.92, P <0.01). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 1.69, 95% CI 1.26-2.26, P <0.001). Other factors associated with abdominal sacrocolpopexy are zip code quartile, payer status, composite comorbidity score, hospital control, and hospital bed size. In the regression model, Black patients remained more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 2, 95% CI 1.26-3.16, P < 0.003). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 1.73, 95% CI 1.31-2.28, P < 0.001). CONCLUSION Abdominal sacrocolpopexy was more likely to occur in patients who identified as Black or Hispanic.
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Affiliation(s)
- Lauren Nicola-Ducey
- From the Department of Obstetrics and Gynecology, Oregon Health Science University
| | - Olivia Nolan
- From the Department of Obstetrics and Gynecology, Oregon Health Science University
| | - Sara Cichowski
- From the Department of Obstetrics and Gynecology, Oregon Health Science University
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Carter-Brooks CM, Brown OE, Ackenbom MF. Pelvic Floor Disorders in Black Women: Prevalence, Clinical Care, and a Strategic Agenda to Prioritize Care. Obstet Gynecol Clin North Am 2024; 51:157-179. [PMID: 38267125 PMCID: PMC11093648 DOI: 10.1016/j.ogc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Pelvic floor disorders are a group of common conditions affecting women of all racial and ethnic groups. These disorders are undertreated in all women, but this is especially magnified in Black people who have been historically marginalized in the United States. This article seeks to highlight the prevalence of pelvic floor disorders in Black women, evaluate the clinical care they receive, examine barriers they face to equitable care, and present a strategic agenda to prioritize the care of Black women with pelvic floor disorders.
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Affiliation(s)
- Charelle M Carter-Brooks
- The George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue NW, Suite 6A- 416, Washington, DC 20037, USA.
| | - Oluwateniola E Brown
- Northwestern University Feinberg School of Medicine, 250 East Superior Avenue Suite 05-2113, Chicago, IL 60601, USA
| | - Mary F Ackenbom
- Magee-Womens Research Institute, University of Pittsburgh, 3240 Craft Place, Suite 226, Pittsburgh, PA 15213, USA
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Downing P, Dong SM, Ardizzone MA, Lynch CD, Hickman LC. Association of Neighborhood-Level Socioeconomic Status With Prolapse Management Decision. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:345-351. [PMID: 38484252 DOI: 10.1097/spv.0000000000001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE This study identifies how neighborhood-level socioeconomic status (SES) may affect patients' treatment decisions for pelvic organ prolapse (POP). OBJECTIVE This study aimed to evaluate the association of neighborhood-level SES with the decision of surgical versus conservative POP management. STUDY DESIGN This was a retrospective cohort study of patients newly diagnosed with POP at a tertiary medical center between 2015 and 2021. Patients lost to follow-up or poor surgical candidates were excluded. Patient characteristics, demographics, and treatment selection were abstracted from the electronic health record. Conservative management was defined as expectant, pessary, and/or pelvic floor physical therapy. Five-digit zip codes were linked to the Area Deprivation Index and used as a surrogate for neighborhood-level SES. Area Deprivation Indices were dichotomized at or below the sample median (less disadvantaged area) and above the sample median (more disadvantaged area). Logistic regression models estimated the odds of choosing surgical versus conservative management as a function of the Area Deprivation Index. RESULTS A total of 459 patients met the eligibility criteria (non-Hispanic White, 88.2%). The median age was 63 years (interquartile range, 52-70 years), and the majority had stage 2 POP (65.7%). Of all patients, 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. Furthermore, 74.7% selected surgical management, and 25.3% chose conservative management. Increasing age and higher Pelvic Organ Prolapse Quantification System stage were significantly associated with selecting surgery (P = 0.01). Women residing in a more disadvantaged area had a 67% increased odds of choosing surgical over conservative management (adjusted odds ratio, 1.67; 95% confidence interval, 1.06-2.64) after adjusting for age, race/ethnicity, body mass index, and Pelvic Organ Prolapse Quantification System stage. CONCLUSIONS Residing in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative POP management.
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Affiliation(s)
- Perrin Downing
- From the Female Pelvic Medicine and Reconstructive Surgery, Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Shirley M Dong
- From the Female Pelvic Medicine and Reconstructive Surgery, Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Courtney D Lynch
- Obstetrics and Gynecology and Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lisa C Hickman
- From the Female Pelvic Medicine and Reconstructive Surgery, Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
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Rozycki SK, Rutledge EC, Nisar T, Yadav GS, Antosh DD. Healthcare disparities and pelvic organ prolapse operative complications: a nationwide analysis. Int Urogynecol J 2023; 34:2893-2899. [PMID: 37548744 DOI: 10.1007/s00192-023-05620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the differences in the incidence of peri-operative complications at the time of pelvic organ prolapse (POP) repair based on health care disparities such as race and socioeconomic status. METHODS The National Inpatient Sample (NIS) database was queried using ICD-9/-10 codes for patients aged >18 years undergoing POP repair in 2008-2018. Demographic information, Elixhauser Comorbidity Index (ECI), insurance status, and peri-operative complications were extracted. Multivariate weighted logistic regression using the discharge weights from NIS were constructed on binary outcomes. Complications with at least 1% incidence were included in the analysis. RESULTS A total of 172,483 POP repair patients were analyzed: 130,022 (75.4%) were white, 10,561 (6.1%) were Black, 21,915 (12.7%) were Hispanic, and 9,985 (5.8%) were of other races. Patients with Medicaid as well as Black, Hispanic, and other races had higher odds of developing postoperative complications such as urinary tract infections, sepsis, and acute renal failure (p value <0.001-0.02). These were also more common in smaller, rural hospitals and with patients with an annual income of $45,999 or less (p value <0.001-0.03). Black and Hispanic patients had lower odds of intraoperative complications such as hemorrhage (aOR 0.77, 95% CI 0.71-0.84; aOR 0.75, 95% CI 0.7-0.8 respectively) or abdominopelvic injury (aOR 0.86, 95% CI 0.81-0.92; aOR 0.93, 95% CI 0.79-0.88 respectively) compared with white patients. CONCLUSION Nonwhite patients with lower socioeconomic status had increased postoperative complications and fewer intraoperative complications from POP surgery, whereas white patients with higher socioeconomic status had more intraoperative complications.
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Affiliation(s)
- Sarah K Rozycki
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA.
| | - Emily C Rutledge
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Tariq Nisar
- Houston Methodist Research Institute, Center for Outcomes Research, Houston, TX, 77030, USA
| | - Ghanshyam S Yadav
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
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Getaneh FW, Ackenbom MF, Carter-Brooks CM, Brown O. Race in Clinical Algorithms and Calculators in Urogynecology: What Is Glaring to Us. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023:02273501-990000000-00108. [PMID: 37211673 DOI: 10.1097/spv.0000000000001371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Feven W Getaneh
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Medstar Georgetown Washington Hospital Center, Washington, DC
| | - Mary F Ackenbom
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Charelle M Carter-Brooks
- Department of Obstetrics and Gynecology, George Washington School of Medicine, Washington, DC; and
| | - Oluwateniola Brown
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL
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Disparities in Benign Gynecologic Surgical Care. Clin Obstet Gynecol 2023; 66:124-131. [PMID: 36657049 DOI: 10.1097/grf.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A person's health is not only affected by their disease states, but also the quality of care and posttreatment sequelae. Research shows that disparities exist in benign gynecologic surgery access to care, techniques, and perioperative outcomes. Surgical education, pathways that emphasize minimally invasive approaches, and patient-centered care that recognizes historical influences on patient perspectives are critical to dampening these disparities.
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Diversity in Pelvic Floor Disorders Research: A Matter of Equity and Inclusion. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:1-4. [PMID: 36548100 DOI: 10.1097/spv.0000000000001308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Health Care Disparities in Surgical Management of Pelvic Organ Prolapse: A Contemporary Nationwide Analysis. Female Pelvic Med Reconstr Surg 2022; 28:207-212. [PMID: 35443256 DOI: 10.1097/spv.0000000000001173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Our objective was to compare the rate of native tissue repair (NTR) versus sacrocolpopexy (SCP) and reconstructive (RECON) versus obliterative repair (OBR) for the treatment of pelvic organ prolapse (POP), evaluating for health care disparities based on race, socioeconomic, and geographic factors. METHODS The National Inpatient Sample database was queried for patients older than 18 years undergoing POP surgery from 2008 to 2018. Baseline demographics, comorbidity index, socioeconomic, and hospital variables were extracted. The weighted t test, Wilcoxon test, and χ2 test were used to compare the rate of (1) NTR versus SCP and (2) RECON vs OBR. Multivariate weighted logistic regression was used to compare while controlling for confounders. Reference groups were White race, Medicare patients, northeast region, small hospital size, and rural location. RESULTS Of 71,262 patients, 67,382 (94.6%) underwent RECON. Patients undergoing OBR were older and had a higher comorbidity score. Multivariate analysis showed the following: (1) Black, Hispanic, and other races; (2) Medicaid patients; (3) patients at urban teaching hospitals are less likely to receive RECON. Patients in the midwest were more likely to receive RECON. Among 68,401 patients, 23,808 (34.8%), and 44,593 (65.19%) underwent SCP and NTR, respectively. Hysterectomy was more common in the NTR group. Multivariate analysis showed the following:(1) Black, Hispanic, and "other" races; (2) uninsured and Medicaid patients; (3) patients in the midwest, south, and west were at higher odds of receiving NTR. Patients in large and urban hospitals were less likely to undergo NTR. CONCLUSIONS Racial, socioeconomic, and geographic disparities exist in surgical management for POP warranting further study to seek to eliminate these disparities.
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Simi AM, Chapman GC, Zillioux J, Martin S, Slopnick EA. Predictors of prolonged admission after outpatient female pelvic reconstructive surgery. Neurourol Urodyn 2022; 41:1031-1040. [PMID: 35347748 PMCID: PMC9314950 DOI: 10.1002/nau.24924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022]
Abstract
Objectives This study aimed to determine factors associated with prolonged hospital admission following outpatient female pelvic reconstructive surgery (FPRS) and associated adverse clinical outcomes. Methods Using the National Surgical Quality Improvement Program database, we identified outpatient FPRS performed 2011–2016. Isolated hysterectomy without concurrent prolapse repair was excluded. Surgeries were classified as major or minor for analysis. The primary outcome was prolonged length of stay (LOS), defined as admission of ≥2 days. Secondary outcomes included complications, readmission and reoperation associated with prolonged LOS. We abstracted data on covariates, and following univariable analysis, performed backward stepwise regression analysis. Results A total of 29645 women were included: 12311 (41.5%) major and 17334 (58.5%) minor procedures. A total of 6.9% (2033) had a prolonged LOS. On full cohort multivariable regression analysis, patient characteristics associated with prolonged LOS were older age (odds ratio [OR]: 1.1 per 10 years, confidence interval [CI]: 1.06–1.1, p < 0.001), frailty (OR: 1.8, 95% CI: 1.3–2.6, p = 0.001), and Caucasian race (OR: 1.2, CI: 1.02–1.3, p = 0.024). Associated surgical factors included having a major surgical procedure (OR: 1.3, CI: 1.2–1.4, p < 0.001), use of general anesthesia (OR: 2.0, CI: 1.5–2.6, p < 0.001) and longer operative time (OR: 2.0, CI: 1.8–2.2, p < 0.001). The occurrence of any complication (10.3% vs. 4.7%, p < 0.001), hospital readmission (4.3% vs. 1.7%, p < 0.001), and reoperation (2.7% vs. 1.0%, p < 0.001) were more likely with prolonged LOS. Conclusions After outpatient FPRS, 6.9% of patients experience an admission of ≥2 days. Prolonged LOS is more common in patients who are older, frail and Caucasian, and in those who have major surgery with long operative time and general anesthesia.
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Affiliation(s)
- Andrea M Simi
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Graham C Chapman
- Division of Urogynecology and Pelvic Floor Disorders, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jacqueline Zillioux
- Department of Urology, Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sarah Martin
- Department of Urology, Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Emily A Slopnick
- Department of Urology, Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Racial and ethnic representation in primary research contributing to pelvic organ prolapse treatment guidelines. Int Urogynecol J 2021; 32:2959-2967. [PMID: 34570246 DOI: 10.1007/s00192-021-04983-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate whether the studies contributing to the national treatment guidelines on pelvic organ prolapse adequately represent the racial and/or ethnic makeup of the American population. METHODS This analysis examines the racial and ethnic makeup of all primary study cohorts contributing to the American College of Obstetricians and Gynecologists/American Urogynecologic Society Practice Bulletin No. 214 on pelvic organ prolapse. References were excluded if they lacked a primary patient population or were from outside the US. Mean proportional representation of racial/ethnic groups was compared to the 2018 United States Census data on race/ethnicity. The representation quotient was also calculated to evaluate for relative representation of each group. Descriptive statistics were used. RESULTS Of the 110 references, 53 primary studies were included in the final analysis with 30 studies reporting on race/ethnicity. On average, 82% (SD = 15%) of study populations were White, while Blacks, Hispanics, and Asians represented 67% (SD = 7%), 4% (SD = 8%), and < 1% (SD = 1%), respectively, differing significantly from the 2018 US Census (p < 0.01.) The representation quotients for White women was 1.36, demonstrating a 36% overrepresentation, while Black, Hispanic, and Asian women were underrepresented among studies of all evidence levels, with representative quotients of 0.50, 0.23, and 0.09, respectively. CONCLUSIONS Our study demonstrates a significant underrepresentation of non-White populations in primary cohorts of studies contributing to the ACOG/AUGS Practice Bulletin No. 214 on POP. This analysis reinforces that more efforts are required to include and report on racial and ethnically diverse cohorts to better serve all patients.
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