From the Department of Obstetrics and Gynecology, Baylor College of Medicine.
Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital.
Female Pelvic Med Reconstr Surg. 2022 Apr 1;28(4):207-212. doi: 10.1097/SPV.0000000000001173.
Our objective was to compare the rate of native tissue repair (NTR) versus sacrocolpopexy (SCP) and reconstructive (RECON) versus obliterative repair (OBR) for the treatment of pelvic organ prolapse (POP), evaluating for health care disparities based on race, socioeconomic, and geographic factors.
The National Inpatient Sample database was queried for patients older than 18 years undergoing POP surgery from 2008 to 2018. Baseline demographics, comorbidity index, socioeconomic, and hospital variables were extracted. The weighted t test, Wilcoxon test, and χ2 test were used to compare the rate of (1) NTR versus SCP and (2) RECON vs OBR. Multivariate weighted logistic regression was used to compare while controlling for confounders. Reference groups were White race, Medicare patients, northeast region, small hospital size, and rural location.
Of 71,262 patients, 67,382 (94.6%) underwent RECON. Patients undergoing OBR were older and had a higher comorbidity score. Multivariate analysis showed the following: (1) Black, Hispanic, and other races; (2) Medicaid patients; (3) patients at urban teaching hospitals are less likely to receive RECON. Patients in the midwest were more likely to receive RECON. Among 68,401 patients, 23,808 (34.8%), and 44,593 (65.19%) underwent SCP and NTR, respectively. Hysterectomy was more common in the NTR group. Multivariate analysis showed the following:(1) Black, Hispanic, and "other" races; (2) uninsured and Medicaid patients; (3) patients in the midwest, south, and west were at higher odds of receiving NTR. Patients in large and urban hospitals were less likely to undergo NTR.
Racial, socioeconomic, and geographic disparities exist in surgical management for POP warranting further study to seek to eliminate these disparities.
本研究旨在比较经 native tissue repair（NTR）与 sacrocolpopexy（SCP）、reconstructive（RECON）与 obliterative repair（OBR）治疗盆腔器官脱垂（POP）的比率，并基于种族、社会经济和地理因素评估卫生保健差异。
本研究从 2008 年至 2018 年，在全国住院患者样本数据库中查询了年龄大于 18 岁的行 POP 手术的患者。提取了基线人口统计学、合并症指数、社会经济和医院变量。采用加权 t 检验、Wilcoxon 检验和 χ2 检验比较（1）NTR 与 SCP 的比率，以及（2）RECON 与 OBR 的比率。采用多变量加权逻辑回归来比较，同时控制混杂因素。参考组为白人、医疗保险患者、东北地区、小医院规模和农村地区。
在 71262 例患者中，67382 例（94.6%）接受了 RECON。接受 OBR 的患者年龄较大，合并症评分较高。多变量分析显示：（1）黑人、西班牙裔和其他种族；（2）医疗补助计划患者；（3）在城市教学医院的患者不太可能接受 RECON。中西部地区的患者更有可能接受 RECON。在 68401 例患者中，分别有 23808 例（34.8%）和 44593 例（65.19%）接受了 SCP 和 NTR。NTR 组中更常行子宫切除术。多变量分析显示：（1）黑人、西班牙裔和“其他”种族；（2）无保险和医疗补助计划患者；（3）中西部、南部和西部的患者接受 NTR 的可能性更高。在大医院和城市医院就诊的患者接受 NTR 的可能性较低。
在 POP 的手术治疗中存在种族、社会经济和地理差异，这需要进一步研究以消除这些差异。
