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Racial and ethnic differences in reconstructive surgery for apical vaginal prolapse
Brittni A J Boyd1, William D Winkelman2, Kavita Mishra3
1Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco, CA.
American Journal of Obstetrics and Gynecology
|May 13, 2021
Summary
Racial and ethnic disparities exist in pelvic organ prolapse surgery. Asian and Pacific Islander women were less likely to have abdominal sacrocolpopexy, while African American and Latina women experienced higher complication rates, including blood transfusions.
Area of Science:
- Urogynecology
- Surgical Outcomes
- Health Disparities
Background:
- Limited literature exists on racial and ethnic health disparities in urogynecologic surgery, specifically for pelvic organ prolapse.
- Understanding these disparities is crucial for equitable patient care and outcomes.
Purpose of the Study:
- To evaluate differences in surgical approach for apical vaginal prolapse based on race and ethnicity.
- To assess postoperative complications associated with different surgical modalities across racial and ethnic groups.
Main Methods:
- Retrospective cohort study of 22,861 women undergoing apical vaginal prolapse repair (2014-2017).
- Data sourced from the American College of Surgeons National Surgical Quality Improvement Program.
- Multivariable logistic regression analyzed associations between race/ethnicity and surgical approach (vaginal vs. abdominal, laparotomy vs. laparoscopy) and 30-day complications.
Main Results:
- Asian and Native Hawaiian/Pacific Islander women were less likely to undergo abdominal sacrocolpopexy compared to White women.
- Latina and Native Hawaiian/Pacific Islander women were less likely to undergo laparoscopic abdominal sacrocolpopexy.
- African American women had higher odds of blood transfusion and deep vein thrombosis/pulmonary embolism, but fewer urinary tract infections.
- Latina women had higher odds of grade II complications.
Conclusions:
- Significant racial and ethnic differences observed in surgical approach and route for apical vaginal prolapse repair.
- Disparities in complication rates, including higher transfusion rates for African American and Latina women, were identified.
- Further research is needed to understand the factors contributing to these differences in care and surgical outcomes.
