Healthcare disparities and pelvic organ prolapse operative complications: a nationwide analysis

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.

The vaginal microbiome and preterm birth

The incidence of preterm birth exceeds 10% worldwide. There are significant disparities in the frequency of preterm birth among populations within countries, and women of African ancestry disproportionately bear the burden of risk in the United States. In the present study, we report a community resource that includes ‘omics’ data from approximately 12,000 samples as part of the integrative Human Microbiome Project. Longitudinal analyses of 16S ribosomal RNA, metagenomic, metatranscriptomic and cytokine profiles from 45 preterm and 90 term birth controls identified harbingers of preterm birth in this cohort of women predominantly of African ancestry. Women who delivered preterm exhibited significantly lower vaginal levels of Lactobacillus crispatus and higher levels of BVAB1, Sneathia amnii, TM7-H1, a group of Prevotella species and nine additional taxa. The first representative genomes of BVAB1 and TM7-H1 are described. Preterm-birth-associated taxa were correlated with proinflammatory cytokines in vaginal fluid. These findings highlight new opportunities for assessment of the risk of preterm birth.

As part of the second phase of Human Microbiome Project, the Multi-Omic Microbiome Study: Pregnancy Initiative presents a community resource to help better understand how microbiome and host profiles change throughout pregnancy as well as to identify new opportunities for assessment of the risk of preterm birth.

Endotracheal Tube Seal and Suction Performance in a Novel Biorealistic Tracheal Model

BACKGROUND

Endotracheal tube (ETT) cuffs create a seal to protect against secretion entry to the lungs. Cuff inflation currently is recommended at 20-30 cm H2O pressure. ETT designs have variable seal performance in bench studies using rigid tracheal models lacking the dynamic characteristics of the human trachea. We compared ETT designs within a new, biorealistic tracheal model to assess cuff and suction performance in the setting of a compliant trachea.

METHODS

Three ETT designs (Mallinckrodt Hi-Lo, KimVent Microcuff, and Sheridan/HVT) were tested for performance by simulant leakage below the cuff and air leakage (measured as return tidal volume ≥ 80% delivered) over a range of cuff (5-25 cm H2O) and end-expiratory pressure (PEEP 0-15 cm H2O). Subglottic suction channel performance was tested in 2 ETTs (TaperGuard Evac [Covidien] and ISIS HVT [Teleflex]) as time to evacuate the simulant.

RESULTS

All ETT cuffs provided effective seals at an inflation pressure of 12 cm H2O when PEEP was ≤ 5 cm H2O. The Microcuff ETT sealed at the lowest pressure of 6 cm H2O, whereas the Sheridan/HVT cuff sealed at 12 cm H2O (P = .01). With a PEEP of 15 cm H2O, a reciprocal increase in air leak occurred, requiring a cuff inflation up to 22 cm H2O to maintain a return tidal volume at ≥ 80% delivered. Suction channel performance improved in the lateral position compared with supine for both ETT designs during continuous 15 mm Hg suction pressure (P = .001).

CONCLUSIONS

Within a novel model with normal trachea compliance, we found all ETT designs tested to seal at lower than current recommended cuff pressures.