Hypothesis / aims of study
Sacrocolpopexy provides the most durable surgical treatment for the management of apical pelvic organ prolapse. Previous literature suggests that minority races/ethnicities experience higher postoperative complications following surgical interventions for pelvic organ prolapse . However, there is a paucity of literature examining disparities that may exist in cost and complications following sacrocolpopexy. We therefore sought to determine the association between socioeconomic factors, procedure charges, and postoperative complications among patients who underwent sacrocolpopexy. We hypothesized that, similar to previous studies exploring costs and complications after any surgery for pelvic organ prolapse , Black patients undergoing sacrocolpopexy would have an increased rate of complications and Hispanic patients would have lower associated procedure costs.
Study design, materials and methods
This is a retrospective cohort study of the 2016-2017 National Inpatient Sample from the Healthcare Cost and Utilization Project, a database that was designed to produce national estimates of inpatient utilization, access, charges, quality, and outcomes . We identified females >18 years of age with an ICD10 diagnosis code of apical prolapse who received open or laparoscopic/robotic sacrocolpopexy. Patients with a previous pelvic cancer diagnosis were excluded. We analyzed relationships between socioeconomic factors, procedure charges and postoperative complications in these patients. Multivariate logistic and linear regressions were used to identify variables associated with increased complications and costs, respectively.
We identified 4,440 women with a median age of 62 who underwent sacrocolpopexy between 2016-2017, of which 18.7% had complications. Hispanic patients had the highest median charge associated with surgical admission for sacrocolpopexy at $51,768 (IQR $35,379 to $79,405), followed by Other ($44,522; IQR $30,596 to $71,600), White ($43,471; IQR $29,733 to $66,476), and Black ($40,634; IQR $28,867 to $60,303) patients. Regression analysis revealed that protective factors against post-operative complications were Hispanic ethnicity (OR 0.76, 95% CI 0.59-0.99) and any concurrent hysterectomy (0.72, 0.61-0.85). Independent risk factors for post-operative complications were laparoscopic approach (3.78, 3.21-4.45) and a higher Charlson Comorbidity Index (Table 1). The most commonly observed post-operative complication was a revision or removal of graft procedure, of which Hispanic patients had the lowest rate (7.1%) and White patients had the highest rate (9.5%). Other complications, including post-operative hemorrhagic anemia and infections, were similar across races/ethnicities (Figure 1). Mesh-specific complications that did not involve a revision or removal procedure were low (<1%) across all ethnicity groups.
Interpretation of results
Hispanic patients observe significantly higher procedure charges and lower post-operative complications for sacrocolpopexy compared to other ethnicity groups. Significant predictors of post-operative complications among women undergoing sacrocolpopexy are laparoscopic approach and a higher Charlson Comorbidity Index. Paradoxically, concurrent hysterectomy served as a protective factor against post-operative complications. The most common postoperative complication experienced by all races/ethnicities was a revision or removal procedure related to the mesh implant, with Hispanics least likely to have this complication. Other mesh-specific complication rates were low regardless of race/ethnicity.