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Perioperative Complication Rates After Colpopexy in African American and Hispanic Women

Roberts, Kasey MD*; Sheyn, David MD; Bretschneider, C. Emi MD; Mahajan, Sangeeta T. MD; Mangel, Jeffrey MD§

Female Pelvic Medicine & Reconstructive Surgery: October 29, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000633
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Objectives The objective of this study was to determine if race affects complication rates after colpopexy.

Methods This was an observational study exempt from institutional review board review. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Current Procedural Terminology codes were used to identify patients with a history of colpopexy. Patients were stratified into 3 groups: White, Hispanic, and African American. Descriptive statistics were reported as means with standard deviations. Three-group comparison was performed using Kruskal-Wallis or 1-way analysis of variance. Pairwise analysis was performed with Student t test, Wilcoxon rank sum test, χ2test, or Fisher exact test. Stepwise backward multivariable logistic regression was used to identify factors associated with the composite complication rate.

Results A total of 13,206 patients met the inclusion and exclusion criteria. Seven hundred thirty-eight patients (5.5%) were African American, and 1210 (9.2%) were Hispanic. The overall complication rate for African Americans, Hispanics, and Whites was 15.0%, 12.0%, and 11.5% (P = 0.006), respectively. The most common complication in the African American group was postoperative transfusion. Multivariable logistic regression found significant associations with perioperative complications and being African American (adjusted odds ratio [aOR], 1.29), higher body mass index (aOR, 1.02), inpatient status (aOR, 1.45), coagulopathy (aOR, 2.77), preoperative transfusion (aOR, 5.09), American Society of Anesthesiologists class 3 or higher (aOR, 1.45), higher preoperative white blood cell count (aOR, 1.04), concomitant sling placement (aOR, 1.19), longer operating time (aOR, 1.003), and longer length of stay (aOR, 1.05).

Conclusions African Americans are at an increased risk of perioperative complications after colpopexy, although the reason for this increase is unknown.

From the *Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, OH;

Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center;

Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic; and

§Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

Correspondence: Kasey Roberts, MD, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH. E-mail: kasey.m.roberts@gmail.com.

The authors have declared they have no conflict of interest.

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