Eleanor M Schmidt, Lauren Nicola-Ducey, Blake Osmundsen, Sara Cichowski
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Bivariate analysis identified demographic and hospital-based differences between native tissue apical suspension procedures versus non-apical suspension during vaginal hysterectomy for prolapse, further analyzed with multivariable logistic regression. A separate analysis examined posthysterectomy prolapse surgical procedures.</p><p><strong>Results: </strong>Of the 62,553 vaginal hysterectomies, 26,094 (41%) were for prolapse. Among these, 14,027 (54%) included apical suspension. The cohort's racial and ethnic identity was 73% non-Hispanic White, 5% Black, 15% Hispanic, 3% Asian, 0% Native American, and 3% other. Multivariable analysis confirmed Black patients were more likely to receive apical suspension compared to non-Hispanic White patients (adjusted odds ratio [aOR] 1.26, 95% CI: 1.04-1.53, P = 0.02), and Hispanic patients were less likely to receive apical suspension (aOR 0.74, 95% CI: 0.63-0.87, P < 0.001). Among 60,074 posthysterectomy prolapse surgical procedures, only 18% included apical suspension. Compared to non-Hispanic Whites, Black, Hispanic, and Asian patients were less likely to receive apical suspension (Black: aOR 0.8, 95% CI: 0.68-0.95, P = 0.013; Hispanic: aOR 0.89, 95% CI: 0.77-1.04, P = 0.14; Asian: aOR 0.52, 95% CI: 0.41-0.66, P < 0.001).</p><p><strong>Conclusions: </strong>The study highlights persistent racial and ethnic disparities in apical suspension provision. There is a notable lack of apical suspension in native tissue repairs, especially after hysterectomy.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8000,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unequal Access and Overall Scarcity of Apical Suspension in Native Tissue Prolapse Repair.\",\"authors\":\"Eleanor M Schmidt, Lauren Nicola-Ducey, Blake Osmundsen, Sara Cichowski\",\"doi\":\"10.1097/SPV.0000000000001637\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Evaluation of racial and ethnic differences in apical suspension during prolapse repair is crucial for equitable gynecological care.</p><p><strong>Objective: </strong>The objective was to assess racial and ethnic disparities in apical suspension during native tissue prolapse repair.</p><p><strong>Study design: </strong>We analyzed data from the 2019 Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample, using Current Procedural Terminology and International Classification of Diseases, Tenth Revision, codes. Bivariate analysis identified demographic and hospital-based differences between native tissue apical suspension procedures versus non-apical suspension during vaginal hysterectomy for prolapse, further analyzed with multivariable logistic regression. A separate analysis examined posthysterectomy prolapse surgical procedures.</p><p><strong>Results: </strong>Of the 62,553 vaginal hysterectomies, 26,094 (41%) were for prolapse. Among these, 14,027 (54%) included apical suspension. The cohort's racial and ethnic identity was 73% non-Hispanic White, 5% Black, 15% Hispanic, 3% Asian, 0% Native American, and 3% other. Multivariable analysis confirmed Black patients were more likely to receive apical suspension compared to non-Hispanic White patients (adjusted odds ratio [aOR] 1.26, 95% CI: 1.04-1.53, P = 0.02), and Hispanic patients were less likely to receive apical suspension (aOR 0.74, 95% CI: 0.63-0.87, P < 0.001). Among 60,074 posthysterectomy prolapse surgical procedures, only 18% included apical suspension. Compared to non-Hispanic Whites, Black, Hispanic, and Asian patients were less likely to receive apical suspension (Black: aOR 0.8, 95% CI: 0.68-0.95, P = 0.013; Hispanic: aOR 0.89, 95% CI: 0.77-1.04, P = 0.14; Asian: aOR 0.52, 95% CI: 0.41-0.66, P < 0.001).</p><p><strong>Conclusions: </strong>The study highlights persistent racial and ethnic disparities in apical suspension provision. There is a notable lack of apical suspension in native tissue repairs, especially after hysterectomy.</p>\",\"PeriodicalId\":75288,\"journal\":{\"name\":\"Urogynecology (Hagerstown, Md.)\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-01-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urogynecology (Hagerstown, Md.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/SPV.0000000000001637\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urogynecology (Hagerstown, Md.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/SPV.0000000000001637","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
重要性：评估脱垂修复中根尖悬吊的种族和民族差异对公平的妇科护理至关重要。目的：目的是评估在原生组织脱垂修复中根尖悬吊的种族和民族差异。研究设计：我们使用现行程序术语和国际疾病分类第十版代码，分析了2019年医疗成本和利用项目全国住院样本和全国门诊手术样本的数据。双变量分析确定了阴道子宫切除术中自然组织根尖悬吊手术与非根尖悬吊手术在人口统计学和医院基础上的差异，并用多变量logistic回归进一步分析。一项单独的分析检查了乳房切除术后脱垂的手术过程。结果：62553例阴道子宫切除术中，脱垂26094例（41%）。其中根尖悬浮14027例（54%）。该队列的种族和民族身份为非西班牙裔白人73%，黑人5%，西班牙裔15%，亚洲人3%，美洲原住民0%，其他3%。多变量分析证实，与非西班牙裔白人患者相比，黑人患者接受根尖悬吊的可能性更大（调整比值比[aOR] 1.26, 95% CI: 1.04-1.53, P = 0.02），西班牙裔患者接受根尖悬吊的可能性更小（aOR 0.74, 95% CI: 0.63-0.87, P < 0.001）。在60,074例乳房切除术后脱垂手术中，只有18%包括根尖悬吊。与非西班牙裔白人相比，黑人、西班牙裔和亚洲患者接受根尖悬置的可能性较低(黑人：aOR 0.8, 95% CI: 0.68-0.95, P = 0.013；西班牙裔：aOR 0.89, 95% CI: 0.77-1.04, P = 0.14；亚洲：aOR 0.52, 95% CI: 0.41-0.66, P < 0.001)。结论：该研究突出了持续的种族和民族差异在根尖中止提供。在原生组织修复中，尤其是子宫切除术后，明显缺乏根尖悬吊。
Unequal Access and Overall Scarcity of Apical Suspension in Native Tissue Prolapse Repair.
Importance: Evaluation of racial and ethnic differences in apical suspension during prolapse repair is crucial for equitable gynecological care.
Objective: The objective was to assess racial and ethnic disparities in apical suspension during native tissue prolapse repair.
Study design: We analyzed data from the 2019 Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample, using Current Procedural Terminology and International Classification of Diseases, Tenth Revision, codes. Bivariate analysis identified demographic and hospital-based differences between native tissue apical suspension procedures versus non-apical suspension during vaginal hysterectomy for prolapse, further analyzed with multivariable logistic regression. A separate analysis examined posthysterectomy prolapse surgical procedures.
Results: Of the 62,553 vaginal hysterectomies, 26,094 (41%) were for prolapse. Among these, 14,027 (54%) included apical suspension. The cohort's racial and ethnic identity was 73% non-Hispanic White, 5% Black, 15% Hispanic, 3% Asian, 0% Native American, and 3% other. Multivariable analysis confirmed Black patients were more likely to receive apical suspension compared to non-Hispanic White patients (adjusted odds ratio [aOR] 1.26, 95% CI: 1.04-1.53, P = 0.02), and Hispanic patients were less likely to receive apical suspension (aOR 0.74, 95% CI: 0.63-0.87, P < 0.001). Among 60,074 posthysterectomy prolapse surgical procedures, only 18% included apical suspension. Compared to non-Hispanic Whites, Black, Hispanic, and Asian patients were less likely to receive apical suspension (Black: aOR 0.8, 95% CI: 0.68-0.95, P = 0.013; Hispanic: aOR 0.89, 95% CI: 0.77-1.04, P = 0.14; Asian: aOR 0.52, 95% CI: 0.41-0.66, P < 0.001).
Conclusions: The study highlights persistent racial and ethnic disparities in apical suspension provision. There is a notable lack of apical suspension in native tissue repairs, especially after hysterectomy.
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