Neighborhood Deprivation Does Not Affect Postoperative Complications After Pelvic Organ Prolapse Surgery in a Managed Health Organization

INTRODUCTION: U.S. women have an 11–19% lifetime risk of surgery for pelvic organ prolapse (POP). National surgical database studies have identified racial and ethnic disparities in POP treatment, underscoring that Black patients are less likely to be operated via minimally invasive approaches and more likely to sustain postoperative complications. Inequitable access to and delivery of care, broader economic inequality, and systemic racism are likely drivers of these disparities. However, studies within managed care organizations that standardize treatment algorithms and referral patterns have shown a leveling of surgical management. Neighborhood Deprivation Index (NDI) is a standardized measure of socioeconomic status that includes race, income, education, employment, and housing quality by geographic location defined by U.S. Census tracts. The multidimensionality of the NDI gives it the advantage of assessing the impact of both racial and socioeconomic factors on care delivery and outcomes. OBJECTIVE: To examine postoperative complication rates following POP surgery across NDI quartiles. METHODS: We conducted a retrospective cohort study of adult patients who underwent surgical treatment of POP between 2015– and 2022 within a managed healthcare organization in Northern California. We included patients with CPT codes reflective of apical (mesh and native tissue) POP repairs, obliterative procedures, and isolated vaginal wall repairs. Postoperative complications were identified via hospital readmissions, emergency department (ED) encounters, and ICD codes corresponding to blood transfusion, venous thromboembolism, urinary tract infection, surgical site infection, sepsis, stroke, or myocardial infarction within 30 days of index surgery. The cohort was divided into NDI quartiles according to the population served by the managed healthcare organization, which includes 4.5 million people in Northern California. The 1st quartile represents the most socioeconomically advantaged, and the 4th quartile represents the most socioeconomically deprived. RESULTS: A total of 8690 patients underwent POP surgery within the study period. NDI quartile was associated with differences in demographic and clinical characteristics: patients in the most deprived (Q4) were more likely to be Hispanic or Black, were younger, had higher parity, higher BMI, and higher prevalence of diabetes and smoking (Table 1). Apical native tissue repair was the most performed procedure (44.5%, N=3865), followed by sacrocolpopexy (21.1%, N=1830), colpocleisis (15.0%, N=1306), and isolated vaginal wall repairs (19.4%, N=1689), and did not differ among NDI quartiles. There were no differences in hospital readmission, ED visit, or postoperative complication rates across NDI quartiles. CONCLUSIONS: We found no notable disparities in postoperative complications or hospital readmissions across NDI quartiles. These findings suggest that healthcare delivery systems that eliminate differential access to specialty care may mitigate the impact of race and socioeconomic status on healthcare outcomes. It is important to acknowledge that disparities likely persist at earlier stages, particularly in entry into the healthcare system. Insured patients with resources to seek evaluation for quality of life conditions such as POP receive equitable surgical care without increased postoperative risks within a managed healthcare organization (Table 2).