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- Title
Racial and ethnic disparity in national practice patterns for stress urinary incontinence surgery.
- Authors
Margulies, Samantha L.; Sakai, Nozomi; Geller, Elizabeth J.
- Abstract
Introduction and hypothesis: There is a paucity of information assessing whether race/ethnicity is associated with differences in surgical treatment of stress urinary incontinence (SUI). The primary objective was to assess for racial/ethnic disparities in SUI surgeries. Secondary objectives were to assess for surgical complication differences and trends over time. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program database, we conducted a retrospective cohort analysis of patients undergoing SUI surgery from 2010 to 2019. Chi-squared or Fisher's exact test and ANOVA were used for categorical and continuous variables respectively. Breslow day score and multinomial and multiple logistic regression models were used. Results: A total of 53,333 patients were analyzed. Using White race/ethnicity and sling surgery as references, Hispanic patients underwent more laparoscopic surgeries (OR1.17 [CI 1.03, 1.33]) and anterior vesico-urethropexy/urethropexies (OR 1.97 [CI 1.66, 2.34]); Black patients underwent more anterior vesico-urethropexy/urethropexies (OR 1.49 [CI 1.07, 2.07]), abdomino-vaginal vesical neck suspensions (OR 2.19 [CI 1.05–4.55]), and inflatable urethral slings (OR 4.28 [CI 1.23–14.90]). White patients had lower rates of inpatient stay (p < 0.0001) and blood transfusion (p < 0.0001) compared with patients who were Black, indigenous, people of color (BIPOC). Over time, Hispanic and Black patients were more likely to undergo anterior vesico-urethropexy/urethropexies than White patients (RR 2.03:1 [CI 1.72–2.40]) and (RR 1.59 CI [1.15–2.20]) respectively. Adjusting for possible confounders, Hispanic and Black patients had a greater chance of having a nonsling surgery, 37% (p < 0.0001) and 44% (p = 0.0001) greater chances respectively. Conclusion: We observed racial/ethnic differences in SUI surgeries. Although causality cannot be proven here, our results confirm previous findings suggesting inequities in care.
- Subjects
AMERICAN College of Surgeons; URINARY stress incontinence; RACIAL inequality; BLACK people; SUBURETHRAL slings; FISHER exact test; MEDICAL slings; VAGINAL surgery
- Publication
International Urogynecology Journal, 2024, Vol 35, Issue 1, p35
- ISSN
0937-3462
- Publication type
Article
- DOI
10.1007/s00192-023-05583-5