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Disparities in Complications After Prolapse Repair and Sling Procedures: Trends From 2010-2018
Nancy E Ringel1, Oluwateniola Brown2, Kristin J Moore3
1Urogynecology & Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT.
Insights
Black women face higher risks of complications, especially vascular issues, after prolapse repair surgery. These complication rates did not decrease over time for Black women, unlike other racial groups.
Area of Science:
- Urogynecology
- Surgical Outcomes Research
- Health Disparities
Background:
- Pelvic organ prolapse and urinary incontinence are common conditions affecting women's quality of life.
- Surgical interventions like prolapse repair and sling procedures are frequently performed.
- Understanding racial and ethnic disparities in surgical outcomes is crucial for equitable healthcare.
Purpose of the Study:
- To compare 30-day complication rates after prolapse repair and sling procedures across different racial/ethnic groups.
- To evaluate trends in these complication rates over time (2010-2018).
Main Methods:
- Analysis of a national outcomes-based database of female patients undergoing prolapse repair and/or sling procedures (2010-2018).
- Stratification by race and ethnicity to compare 30-day postoperative complication rates.
- Multivariable logistic regression and trend analysis (p-trend) were used to adjust for confounders and evaluate temporal changes.
Main Results:
- A total of 70,540 prolapse repairs and 23,968 sling procedures were analyzed.
- Black women had the highest complication rates after prolapse repairs (11%) and significantly higher odds of any complication (aOR 1.15) and vascular complications (aOR 2.50) post-adjustment.
- Hispanic women showed higher odds of vascular complications after both prolapse repair (aOR 1.47) and sling procedures (aOR 2.40).
- While vascular complication rates decreased for non-Black women after prolapse repair from 2010-2018, rates among Black women did not show a similar decrease.
Conclusions:
- Black women experience disproportionately higher rates of postoperative complications, particularly vascular complications, following prolapse repair.
- Vascular complication rates after prolapse repair have not improved for Black women over time, unlike other racial/ethnic groups.
- Hispanic women face elevated risks for vascular complications following both prolapse repair and sling procedures.
Objective:
To compare 30-day complication rates after prolapse repair and sling procedures across racial/ethnic groups, and evaluate trends over time.
Methods:
We identified female patients in a national outcomes-based database who underwent prolapse repair and/or sling procedures between January 1, 2010 and December 31, 2018, stratified by race and ethnicity, and compared 30-day postoperative complication rates. Multivariable logistic regression adjusted for confounders. Trends in complication rates over time were evaluated using a test for trend (p-trend).
Results:
We identified 70,540 prolapse repairs and 23,968 sling procedures. Following prolapse repairs, Black women had the highest complication rates (11%, vs 8% for Hispanic and 9% for both White and Other race/ethnicity women, P <0.01). Following sling procedures, there were few differences in complication rates between groups. After adjustments, Black women still experienced higher odds of any complication (aOR 1.15, 95% CI 1.03-1.29), particularly a vascular complication (venous thromboembolism or transfusion) (aOR 2.50, 95% CI 2.05-3.04) following prolapse repair procedures. Hispanic women had higher odds of vascular complications after prolapse repair (aOR 1.47, 95% CI 1.23-1.76) and slings (aOR 2.40, 95% CI 1.53-3.76). Trends from 2010-2018 showed a decrease in vascular complication rates among non-Black women after prolapse repairs, but rates among Black women did not decrease.
Conclusion:
Black women have higher odds of experiencing postoperative complications after prolapse repair procedures, particularly vascular complications. Vascular complication rates after prolapse repair decreased over time for all racial/ethnic groups except Black women. Hispanic women have higher odds of vascular complications after prolapse repair and slings than other racial/ethnic groups.
