Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA.
Houston Methodist Research Institute, Center for Outcomes Research, Houston, TX, 77030, USA.
Int Urogynecol J. 2023 Dec;34(12):2893-2899. doi: 10.1007/s00192-023-05620-3. Epub 2023 Aug 7.
The objective of this study was to evaluate the differences in the incidence of peri-operative complications at the time of pelvic organ prolapse (POP) repair based on health care disparities such as race and socioeconomic status.
The National Inpatient Sample (NIS) database was queried using ICD-9/-10 codes for patients aged >18 years undergoing POP repair in 2008-2018. Demographic information, Elixhauser Comorbidity Index (ECI), insurance status, and peri-operative complications were extracted. Multivariate weighted logistic regression using the discharge weights from NIS were constructed on binary outcomes. Complications with at least 1% incidence were included in the analysis.
A total of 172,483 POP repair patients were analyzed: 130,022 (75.4%) were white, 10,561 (6.1%) were Black, 21,915 (12.7%) were Hispanic, and 9,985 (5.8%) were of other races. Patients with Medicaid as well as Black, Hispanic, and other races had higher odds of developing postoperative complications such as urinary tract infections, sepsis, and acute renal failure (p value <0.001-0.02). These were also more common in smaller, rural hospitals and with patients with an annual income of $45,999 or less (p value <0.001-0.03). Black and Hispanic patients had lower odds of intraoperative complications such as hemorrhage (aOR 0.77, 95% CI 0.71-0.84; aOR 0.75, 95% CI 0.7-0.8 respectively) or abdominopelvic injury (aOR 0.86, 95% CI 0.81-0.92; aOR 0.93, 95% CI 0.79-0.88 respectively) compared with white patients.
Nonwhite patients with lower socioeconomic status had increased postoperative complications and fewer intraoperative complications from POP surgery, whereas white patients with higher socioeconomic status had more intraoperative complications.
本研究的目的是评估基于健康差异（如种族和社会经济地位），在接受盆腔器官脱垂（POP）修复时围手术期并发症发生率的差异。
使用 2008 年至 2018 年 ICD-9/-10 代码，从国家住院患者样本（NIS）数据库中查询年龄>18 岁接受 POP 修复的患者。提取人口统计学信息、Elixhauser 合并症指数（ECI）、保险状况和围手术期并发症。使用 NIS 的出院权重构建二元结果的多变量加权逻辑回归。将至少 1%发生率的并发症纳入分析。
共分析了 172483 例 POP 修复患者：130022 例（75.4%）为白人，10561 例（6.1%）为黑人，21915 例（12.7%）为西班牙裔，9985 例（5.8%）为其他种族。拥有医疗补助计划以及黑人、西班牙裔和其他种族的患者发生尿路感染、败血症和急性肾衰竭等术后并发症的几率更高（p 值<0.001-0.02）。在较小的农村医院以及年收入为 45999 美元或以下的患者中，这些情况更为常见（p 值<0.001-0.03）。与白人患者相比，黑人患者和西班牙裔患者术中并发症（如出血，aOR 0.77，95%CI 0.71-0.84；aOR 0.75，95%CI 0.7-0.8）或腹盆腔损伤（aOR 0.86，95%CI 0.81-0.92；aOR 0.93，95%CI 0.79-0.88）的几率较低。
社会经济地位较低的非白人患者 POP 手术后的并发症更多，而社会经济地位较高的白人患者术中的并发症更多。
