SUFU 2021: Evaluating the Association of Frailty and Racial and Socioeconomic Disparities on Postoperative Complications Among Patients Undergoing Apical Pelvic Organ Prolapse Surgery

( The study‚Äôs aim was to show how frailty affects perioperative complications in women undergoing pelvic organ prolapse (POP) surgery. They sought to determine (1) the role of frailty on postoperative complications and (2) the association of racial and socioeconomic differences between frailty and postoperative complications among women undergoing apical prolapse repair. This was a retrospective cohort study of the 2016-2017 National Inpatient Sample from the Healthcare Cost and Utilization Project analyzing relationships between frailty, as determined by the Hospital Frailty Risk Score (HFRS), a predictive tool based on International Classification of Diseases (ICD-10 codes), Charlson Comorbidity Index (CCI) and postoperative complications in women undergoing apical POP repair. 9,028 women were identified, with a 12.7% frailty rate and 12.2% complication rate. Multiple regression models indicated women of the white race, urban hospital location, large hospital bed size, older age, and Medicaid payers were more likely to be frail. Frailty was most predictive of postoperative complications (OR 5.77, 95% CI 4.97-6.70) while age was a negative predictor (0.98, 0.98-0.99).  Black race (Black 1.26, 0.98-1.61), rural hospital location (1.31, 1.01-1.69), Medicaid payer status (1.57, 1.30-1.90), and high CCI (4.45, 3.49-5.67) were also associated with increased risk of postoperative complications.

The authors concluded that apical POP procedure patients who are frail were more likely to be white, older, pay with medicare, undergo surgery at a large, urban hospital, and experienced complications. Race and hospital size did not have a significant ability to predict complications. Paradoxically, patients at rural hospitals were more likely to experience complications despite being less frail overall. Medicare payers were at higher risk as well.

Presented by: Sirpi Nackeeran Alejandra Guevara Mendez, Camilo Acosta, Laura Martin, Raveen Syan, Katherine Amin, The University of Miami, Miller School of Medicine, University of Miami, Department of Urology, University of Miami, Department of Medicine

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting.