Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：本研究的目的是根据种族和社会经济状况等医疗保健差异，评估盆腔器官脱垂（POP）修复时围手术期并发症发生率的差异。
方法：针对2008-2018年接受POP修复的年龄>18岁的患者，使用ICD-9/-10代码查询了国家住院患者样本（NIS）数据库。人口统计信息,Elixhauser合并症指数（ECI），保险状况,并提取围手术期并发症。根据二元结果构建使用来自NIS的出院权重的多变量加权逻辑回归。分析中包括至少1%发生率的并发症。
结果：共分析了172,483例POP修复患者：130,022例（75.4％）为白人，10,561（6.1％）为黑人，21,915（12.7%）是西班牙裔，其他种族为9,985人(5.8%)。医疗补助和黑人患者，西班牙裔,和其他种族有更高的几率发生术后并发症，如尿路感染，脓毒症,和急性肾功能衰竭（p值<0.001-0.02）。这些在较小的，农村医院和年收入45,999美元或以下的患者（p值<0.001-0.03）。与白人患者相比，黑人和西班牙裔患者发生术中并发症的几率较低，例如出血（分别为aOR0.77，95％CI0.71-0.84；aOR0.75，95％CI0.7-0.8）或腹骨盆损伤（分别为aOR0.86，95％CI0.81-0.92；aOR0.93，95％CI0.79-0.88）。
结论：社会经济地位较低的非白人患者因POP手术而术后并发症增加，术中并发症减少，而社会经济地位较高的白人患者术中并发症较多.
方法：针对2008-2018年接受POP修复的年龄>18岁的患者，使用ICD-9/-10代码查询了国家住院患者样本（NIS）数据库。人口统计信息,Elixhauser合并症指数（ECI），保险状况,并提取围手术期并发症。根据二元结果构建使用来自NIS的出院权重的多变量加权逻辑回归。分析中包括至少1%发生率的并发症。
结果：共分析了172,483例POP修复患者：130,022例（75.4％）为白人，10,561（6.1％）为黑人，21,915（12.7%）是西班牙裔，其他种族为9,985人(5.8%)。医疗补助和黑人患者，西班牙裔,和其他种族有更高的几率发生术后并发症，如尿路感染，脓毒症,和急性肾功能衰竭（p值<0.001-0.02）。这些在较小的，农村医院和年收入45,999美元或以下的患者（p值<0.001-0.03）。与白人患者相比，黑人和西班牙裔患者发生术中并发症的几率较低，例如出血（分别为aOR0.77，95％CI0.71-0.84；aOR0.75，95％CI0.7-0.8）或腹骨盆损伤（分别为aOR0.86，95％CI0.81-0.92；aOR0.93，95％CI0.79-0.88）。
结论：社会经济地位较低的非白人患者因POP手术而术后并发症增加，术中并发症减少，而社会经济地位较高的白人患者术中并发症较多.
