Racial and Ethnic Disparities in Sacrocolpopexy Approach

Objectives: Current data show disparities for black, Indigenous and people of color (BIPOC) when comparing open versus minimally invasive hysterectomy. It is unknown if a similar disparity exists in surgical management of pelvic organ prolapse. Our objective was to determine whether racial and/or ethnic disparities exist for open abdominal (ASC) versus minimally-invasive (MISCP) sacrocolpopexy.

Methods: We used cross-sectional data of the Healthcare Cost and Utilization Project National Inpatient Sample and the Nationwide Ambulatory surgery sample inclusive of the entire year 2019. The cohort was identified utilizing Current Procedural Terminology and ICD-10 codes. Bivariate analysis identified demographic and perioperative differences between ASC versus MISCP which were then compared in a multivariable logistic regression model.

Results: In total 41,837 patients underwent sacrocolpopexy, 35,820 (85.6%) had a MISCP and 6,016 (14.4%) had ASC (Figure 1). The mean age was 60 (±12.5). The cohort’s racial and ethnic identity was non-Hispanic White 31,634 (75.65%), Black 2,754 (6.59%), Hispanic 5,137 (12.29%), Asian 791 (1.89%), Native American 121 (0.29%), and Other 1,379 (3.30%). Individuals self-identifying as more than one race or ethnic category were considered other. In an unadjusted analysis, Black patients were more likely to undergo a ASC compared to non-Hispanic White patients (OR 2.14, 95% CI 1.16-3.92, p < .01). Hispanic identification as well was more likely to undergo ASC compared to White (OR 1.69, 95% CI 1.26, 2.26, p < .001). Other factors associated with ASC are: zip code quartile, payor status, presence of hypertension, hospital control, and hospital bed size. In the regression model controlling for the variates listed above, Black patients remained more likely to undergo ASC compared to those who identified as White (adjusted odds ratio [aOR] 2, 95% CI: 1.26-3.16, p < 0.003) (Table 1). Hispanic patients were also more likely to undergo ASC compared to those who identified as White (aOR 1.73, 95% CI 1.31-2.28, p < 0.001).


Conclusions: Open sacrocolpopexy was more likely to occur in patients who identified as Black or Hispanic, compared to non-Hispanic White. Women of color undergoing surgery for prolapse are subjected to lower standards of surgical care, mirroring what persists in other gynecologic surgical care. Additional research and policies are needed promote health equity for BIPOC patients seeking surgical options for pelvic organ prolapse.