07 Racial and ethnic disparities in complications after apical support and sling procedures- national trends over time: A secondary analysis of the national surgical quality improvement program database

Abstract

Racial and ethnic disparities in complications rates after FPMRS procedures exist. Prior studies have shown that Black women have higher complication rates than other racial and ethnic groups; however, it is not known whether these complication rates have changed over time. We sought to compare 30-day complication rates after apical support and sling procedures across racial/ethnic groups, and evaluate trends over time. Using a nationally validated, outcomes-based database we identified women who underwent apical support procedures and/or sling procedures between 2014 and 2018 using CPT codes, and stratified by race and ethnicity into four groups (1. Black, 2. White, 3. Hispanic, and 4. Other). Complication rates were calculated based on frequency of any complications reported in the 30-day postoperative period. Group comparisons were performed using one-way analysis of variance (ANOVA) to compare complication rates between groups. Multivariable logistic regression was used to adjust for operative year, age, BMI, diabetes, and hypertension requiring medication. We identified 51,921 surgeries with apical support procedures and 15,409 sling procedures over the five-year period. Among women who underwent apical support procedures, complication rates differed between racial and ethnic groups with the highest complication rates noted in Black women at 11.5% (Table 1). There were few significant differences in complication rates between groups following sling procedures (Table 1). From 2014 to 2018 complication rates remained stable in Black women for both apical support procedures and slings over time, but there was a slight decrease in complication rates among women who had apical support procedures in other racial/ethnic groups (Table 2). After adjusting for confounders, Black women still experienced a higher odds of any complication (aOR = 1.16, 95% CI = 1.06-1.30), particularly a vascular complication (aOR = 2.48, 95% CI = 2.03-3.03) when compared with other racial/ethnic groups following apical support procedures. Regression analysis showed no significant differences between groups for sling procedures. Black women are at higher risk of postoperative complication after apical prolapse procedures. While complication rates have largely remained stable over time for Black women, complication rates have gone down for women of other racial/ethnic groups. Further study is needed to understand the reasons behind these disparities. The lack of change over time highlights the urgency in developing a plan to identify and address the root causes for disparities in our field.View Large Image Figure ViewerDownload Hi-res image Download (PPT)