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Rapid Fire Oral Presentations 03: Disparities, Office Practice & Special Populations

SES and Obliterative vs Reconstructive Pelvic Surgery in a Managed Care Setting

Friday, October 25, 2024
4:54 PM – 4:57 PM EDT
Location: Independence Ballroom A-D (Meeting Level 4)
Association Between Socioeconomic Status and Odds of Undergoing Obliterative vs Reconstructive Pelvic Organ Prolapse Surgery
Objectives: A higher proportion of Black and Latina patients underwent obliterative compared to reconstructive prolapse procedures for pelvic organ prolapse (POP) based on two different national databases. This may be indicative of decreased access to Urogynecologists, who perform the vast majority of reconstructive surgeries in the United States. We aimed to investigate whether this disparity exists in a managed care setting, where differences in access to subspecialists are minimized.

Methods: This is a secondary analysis of a retrospective cohort study of patients who underwent apical POP surgery within a large managed care system between 2014 and 2017. Demographic information, comorbidities, and prolapse stage were abstracted from the electronic medical record. Chi square tests were used to compare categorical variables and a multivariate logistic regression was used to control for confounders impacting the selection of POP surgery.

Results: A total of 2810 patients across 19 medical centers underwent apical prolapse surgery, and were included in this sub-analysis. Thirty six percent are non-Hispanic White, 5.7% are non-Hispanic Black, and 52.4% are Hispanic/Latina (HL). HL identity was initially associated with 0.59 odds of undergoing obliterative surgery compared to reconstructive surgery. However, when controlled for age, income, ASA score, medical centers, education and POP stage, there was no longer any significant difference by race/ethnicity. No differences were observed by primary language or income level.

Conclusions: Within this managed care setting, no disparities in obliterative vs reconstructive surgery were observed when providers and patient-level confounders such as prolapse stage and comorbidities were controlled for. This suggests that access to subspecialty care and other structural factors may be large contributors to disparities seen in the US, and warrants further study.
Disclosure(s):
Samantha DeAndrade, MD, MPH: No financial relationships to disclose
Krystal DePorto, MD: No financial relationships to disclose
K. Marie Douglass, MD/MPH: No financial relationships to disclose
Taylor R. Whitaker, MD: No financial relationships to disclose
AnMarie Nguyen, PhD: No financial relationships to disclose
Tajnoos Yazdany, MD: No financial relationships to disclose
Christopher F. Tenggardjaja, MD: No financial relationships to disclose

    Rapid Fire Presenter(s)

  • Samantha DeAndrade, MD, MPH (she/her/hers)

    Physician
    Beth Israel Deaconess Medical Center
    Boston, Massachusetts, United States

    Disclosure(s): No financial relationships to disclose

    • Co-Author(s)

  • KD

    Krystal DePorto, MD

    Resident
    Kaiser Permanente Los Angeles Medical Center
    Los Angeles, California, United States

    Disclosure(s): No financial relationships to disclose

  • K. Marie Douglass, MD/MPH (she/her/hers)

    Fellow
    Harbor-UCLA Medical Center
    Los Angeles, California, United States

    Disclosure(s): No financial relationships to disclose

  • Taylor R. Whitaker, MD (she/her/hers)

    Fellow
    Harbor-UCLA
    Los Angeles, California, United States

    Disclosure(s): No financial relationships to disclose

  • AN

    AnMarie Nguyen, PhD

    Analyst
    Kaiser Permanente
    Cypress, California, United States

    Disclosure(s): No financial relationships to disclose

  • TY

    Tajnoos Yazdany, MD (she/her/hers)

    Vice Chair of Education, Program Director
    Harbor UCLA medical center
    Playa vista, California, United States

    Disclosure(s): No financial relationships to disclose

  • CT

    Christopher F. Tenggardjaja, MD

    Fellowship site director
    Kaiser Permanente
    Los Angeles, California, United States

    Disclosure(s): No financial relationships to disclose