Proceeding to Surgery—Socioeconomic Factors May Influence a Patient’s Decision to Proceed With Pelvic Floor Surgery

INTRODUCTION: Patients may choose to undergo pelvic floor surgery for a variety of reasons such as symptom bother, failure of conservative treatment, and concern for progression of their disease. Additionally, there may be more nuanced reasons driving a patient toward surgery, such as a lack of conservative therapy options closer to home or the inability to afford more conservative options. The Rural Urban Disadvantage Advantage (RUDA) and Area Deprivation Index-9 (ADI) scores are measures of a neighborhood’s socioeconomic disadvantage. OBJECTIVE: Our objective was to evaluate if worsening RUDA or ADI were associated with likelihood to proceed to surgery and with time to having surgery. Our hypothesis is that patients from more disadvantaged neighborhoods will choose to pursue surgical treatment over conservative therapy. METHODS: This is an IRB-exempt (IRB 2022-0030) retrospective cohort study of new patient visits that occurred between January 2019 and September 2022 in a single academic center. Demographic and clinical data was abstracted from the electronic medical record. Using 5- and 9-digit zip codes, the patients were given RUDA and ADI scores. Time to surgery was calculated as days from new patient visit to initial surgery. RESULTS: Approximately 2630 patients new patient visits occurred during this time. Mean age was 57.2 (SD 16.2). Most patients were White. 40% had a primary diagnosis of incontinence, and 39.4% had a primary diagnosis of pelvic organ prolapse. Mean PFDI-20, POPDI-6, CRADI-8, and UDI-6 scores were 91.2 (SD 54.6), 39.8 (SD 24.9), 22.8 (SD 20.4), and 29.5 (SD 22.22), respectively. Approximately one-quarter of patients proceeded with surgical intervention for their pelvic floor disorder, and mean days to surgery was 209.6 (SD 268.1). Average distance traveled to clinic was 26.1 minutes. Patients living in Urban or Rural Advantaged zip codes were more likely to undergo surgery than those living in Urban or Rural Disadvantaged zip codes (p<0.001). However, time to surgery was shorter for those living in Disadvatanged zip codes (0.053). Those living in advantaged areas were likely to have lower PFDI, CRADI-8, and POPDI-6 scores. See Table 1. When considering the ADI-9 scores, those living in the most advantaged and least advantaged zip codes were less likely to undergo surgery. PFDI, POPDI-6, CRADI8, and UDI-6 scores as the zip codes became more disadvantaged. Time to surgery became significantly shorter as the zip code became more disadvantaged (p=0.005). See Table 2. CONCLUSIONS: These data suggest that many factors may affect a patient’s decision to undergo surgery. A patient may have a stronger desire for surgery if they come from a far distance and would prefer to have definitive treatment as to not have to drive back and forth to clinic. Conversely, a patient with very severe symptoms may delay surgery as they cannot afford to be off of work. A deeper understanding of the biopsychosocial aspects that influence a patient’s decision to elect surgery may help interventions designed to reduce urogynecologic healthcare disparities.