Impact of race and socioeconomic status on complications in pelvic organ prolapse repair


      The objective of the study was to investigate the impact of race and socioeconomic status, as reflected by insurance type, on pelvic organ prolapse (POP) procedures using the National Inpatient Database (NIS).

      Materials and Methods

      NIS was queried using ICD-9/10 codes for patients aged >18 years undergoing POP repair. Demographic information, Elixhauser comorbidity index (ECI), insurance status, and postoperative complications were extracted. Race and ethnicity are reported as one variable by NIS. Stepwise multivariate weighted logistic regression using the discharge weights from NIS were constructed on binary outcomes. % Incidence, odds ratio (OR) and 95% confidence intervals (CI) are reported. Complications, such as organ injury and wound infection, with <1% incidence were excluded.


      192,400 POP repair patients were analyzed. 130,022 (67.5%) were white, 10,561 (5.5%) were African American, 21,915 (11.4%) were Hispanic, and 9,985 (5.2%) were other races. African American, Hispanic, and other races had higher odds of developing UTI, sepsis, and acute renal failure compared to whites (Table 1). African Americans and Hispanics had lower odds of developing postoperative hemorrhage or abdominopelvic complications compared to white patients (Table 1). Other races had lower odds of postoperative hemorrhage and no difference in abdominopelvic complications compared to whites (Table 1). Privately insured patients had lower odds of UTI, sepsis, acute renal failure, and hemorrhage compared to all other insurance types (Table 2).


      Race and insurance status impact a patient’s risk for sustaining certain postoperative complications. Even after controlling for age and ECI, non-white patients were more likely to have UTIs, sepsis, and acute renal failure. Patients with private insurance were less likely to have postoperative complications. The study is limited by the majority of the population being white patients and the generally rare incidence of complications. Continued efforts are needed to address the cause of health disparities and eliminate them from medical care.
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