Abstract

BACKGROUND: There is limited literature identifying racial and ethnic health disparities among surgical modalities and outcomes in the field of urogynecology and specifically pelvic organ prolapse surgery.OBJECTIVE: To evaluate differences in surgical approach for apical vaginal prolapse and postoperative complications by race and ethnicity STUDY DESIGN: This is a retrospective cohort study of women undergoing surgical repair for apical vaginal prolapse between 2014 and 2017 using data from the American College of Surgeons National Surgical Quality Improvement Program. Patients were eligible for inclusion if they underwent either a vaginal colpopexy or abdominal sacrocolpopexy (ASC). Abdominal sacrocolpopexy cases were further divided into those performed by laparotomy and those performed by laparoscopy. Multivariable logistic regression models that controlled for age, comorbidities, American Society of Anesthesiologists physical status classification, and concurrent surgery were used to determine if race and ethnicity is associated with type of colpopexy (vaginal vs. abdominal) or the surgical route of abdominal sacrocolpopexy. Similar models that also controlled for surgical approach were used to assess 30-day complications by race and ethnicity.RESULTS: A total of 22,861 eligible surgical cases were identified, of which 12,337 (54%) were a vaginal colpopexy and 10,524 (46%) were an abdominal sacrocolpopexy. Among patients who had an abdominal sacrocolpopexy, 2,262 (21%) were performed via laparotomy and 8,262 (79%) via laparoscopy. The study population was 70% White, 9% Latina, 6% African American, 3% Asian, 0.6% Native Hawaiian or Pacific Islander, 0.4% American Indian or Alaska Native, 11% Unknown. In multivariable analysis, Asian and Native Hawaiian or Pacific Islander women were less likely to undergo abdominal sacrocolpopexy compared with White women (OR 0.82, 95% CI 0.68-0.99 and OR 0.56, 95% CI 0.39-0.82, respectively). Among women who underwent an abdominal sacrocolpopexy, Latina women and Native Hawaiian or Pacific Islander women were less likely to undergo a laparoscopic approach compared with White women (OR 0.68, 95% CI 0.58-0.79 and OR 0.31, 95% CI 0.1-0.56, respectively). Complication rates also differed by race and ethnicity. Following a colpopexy, African American women were more likely to need a blood transfusion (OR 3.04, 95% CI 1.95-4.73, p=<0.001) and have a deep vein thrombosis/pulmonary embolus (OR 2.46, 95% CI 1.10-5.48, p=0.028), but less likely to present with postoperative urinary tract infections (OR 0.68, 95% CI 0.49- 0.96, p=0.028) compared with White women in multivariable regression models. Using the Clavien-Dindo classification system, Latina women had a higher odds of developing Grade II complications compared with White women in multivariable models (OR 1.25, 95% CI 1.04-1.51, p=0.02).CONCLUSION(S): There are racial and ethnic differences in the type and route of surgical repair for apical vaginal prolapse. Specifically, Latina and Pacific Islander women were less likely to undergo a laparoscopic approach to abdominal sacrocolpopexy compared with White women. While complications were uncommon, there were several complications including blood transfusions that were higher among African American and Latina women. Additional studies are needed to better understand and describe associated factors for these differences in care and surgical outcomes.

View details for DOI 10.1016/j.ajog.2021.05.002

View details for PubMedID 33984303