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Published on: October 25, 2024
Health Care Disparities in Patients Undergoing Surgery for Pelvic Floor Disorders: A Systematic Review
Cecilia K Wieslander1, Cara L Grimes, Ethan M Balk
1Division of Urogynecology, Departments of Obstetrics & Gynecology and Urology, David Geffen School of Medicine at UCLA, and the Division of Urogynecology, Departments of Obstetrics & Gynecology and Urology, UCLA Health, Los Angeles, and the Division of Urogynecology, Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, California; the Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville Health, Louisville, Kentucky; the Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Florida Health, Jacksonville, Florida; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, and the Division of Urogynecology, Department of Obstetrics & Gynecology, Houston Methodist Hospital, Houston, Texas; the Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut; the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; the Division of Urogynecology & Reconstructive Pelvic Surgery, Cooper Health University, Cooper Medical School at Rowan University, Camden, New Jersey; Boston Urogyn, Wellesley, Massachusetts; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico.
Objective:
To explore how patient characteristics related to health care disparities are associated with access to care and clinical outcomes among patients receiving surgical treatment for pelvic floor disorders in the United States.
Data Sources:
We searched MEDLINE, EMBASE, and ClinicalTrials.gov through March 25, 2024.
Methods Of Study Selection:
Patient characteristics related to health care disparities included race, ethnicity, geographic location, and insurance status, among others. Outcomes included access to surgery, surgical outcomes, and patient-reported outcomes. Eligible studies reported multivariable regression analyses that included at least one patient characteristic related to health care disparities and an included study outcome. For each outcome, we describe the consistency (in direction), strength of association, and number of studies of the patient characteristic related to health care disparities. Meta-analysis was not performed because of study heterogeneity. This review was conducted by the Systematic Review Group of the Society of Gynecologic Surgeons.
Tabulation, Integration, And Results:
Of 6,853 abstracts screened, 42 studies with a total of 84 multivariable analyses were included. Characteristics associated with decreased access to apical suspension during prolapse surgery included being from a rural area or of Hispanic ethnicity, and Black racial identity was associated with decreased access to mesh augmentation. Black racial identity and Hispanic ethnicity were also associated with decreased access to reconstructive prolapse repair compared with obliterative procedures and hemorrhage during prolapse repair; older age and having Medicare insurance were associated with increased risk of overall complications. Not being from the Northeast was associated with increased risk of overall complications after prolapse surgery. Patients from a minority race were less likely to undergo reoperation after stress urinary incontinence (SUI) surgery. Black race was not associated with complications after SUI surgery.
Conclusion:
Patients in minoritized groups in the United States, those with Medicare insurance, and those not from the Northeast were more likely to have health care disparities related to surgical treatment for pelvic floor disorders.
Systematic Review Registration:
PROSPERO, CRD42021234511.
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