African American women are at higher risk for adverse outcomes following prolapse surgery

Risk of high-grade complications after surgical treatment for pelvic organ prolapse is greater among African American women, according to findings from a recent study.¹

The study collected data from the National Surgical Quality Improvement Program database from patients who underwent surgery for pelvic organ prolapse between 2011 to 2020.

The results were presented at the 2023 American Urological Association Annual Meeting in Chicago, Illinois.

“The main highlight to take away from this study was that despite controlling for several comorbid factors, we still found that African American women were at significantly higher risk of high-grade complications for pelvic organ surgery,” said Anjali Kapur, MD, in a presentation of the findings. Kapur is a urology resident at Stony Brook Medicine in Stony Brook, New York.

The study collected data from the National Surgical Quality Improvement Programdatabase from patients who underwent surgery for pelvic organ prolapse between 2011 to 2020. In total, 72,400 patient cases were included for analysis.

Cases were identified using CPT codes for minimally invasive and open sacrocolpopexy, vaginal vault suspension, anterior colporrhaphy, vaginal repair, enterocele/rectocele repair, and obliterative surgery. Postoperative 30-day complications were classified as low-grade (Clavien-Dindo I-II complications) or high-grade (Clavien-Dindo III-IV complications).

Upon multivariate logistic regression, data showed that African American women were at a 35% increased risk of Clavien Dindo III-IV complications (P < .01). This held even when the investigators adjusted for age, past medical history, smoking status, and type of surgery.

Conversely, Asian women had a 42% decreased risk of Clavien Dindo III-IV complications (P < .01) and a 19% decreased risk of Clavien Dindo I-II complications (P < .05) compared with Caucasian patients. Hispanic women also had a 23% decreased risk of Clavien Dindo III-IV complications (P < .01).

The investigators also found that women aged over 65 had a 14% decreased risk of Clavien-Dindo I-II complications (P < .01) and 15% decreased risk of Clavien-Dindo III-IV complications (P < .01).

Patients with comorbid dyspnea, severe COPD, ascites, congestive heart failure, disseminated cancer, open wound/infection, steroids/immunosuppression, smoking history, and a BMI greater than 30 were also associated with a higher risk for Clavien-Dindo III-IV complications (P < .05). Operative complications associated with higher risk of high-grade complications were open sacrocolpopexy, obliterative surgery, and longer operative time.

The authors concluded, “Further research is needed to elucidate implicit biases or disparities in health care that may contribute to adverse outcomes.”

Reference

1. Aalami Harandi A, Kapur A, Kim J. Racial disparities in complications after surgical treatment of pelvic organ prolapse. Presented at: American Urological Association Annual Meeting, April 28-May 1, Chicago. Abstract MP07-16