Social Determinants and Time to Surgery for Pelvic Floor Disorders

IMPORTANCE: Patients with social determinants of health (SDoH)-related barriers have reduced access to care for pelvic floor disorders (PFDs), but whether SDoH influence time to surgical decision making is unknown. OBJECTIVES: We aimed to assess the association of various SDoH with time to surgical decision making in patients who had surgery for a PFD. STUDY DESIGN: We conducted a retrospective cross-sectional study of patients who underwent surgery for overactive bladder, stress urinary incontinence, or pelvic organ prolapse between January 2013 and December 2023 at a large metropolitan health care system in Michigan. Patients were stratified by residence. Associations of demographic, clinical, and SDoH variables with time to surgical decision were tested with nonparametric tests and multivariable linear regression. Pandemic period comparisons were assessed with nonparametric and categorical tests. RESULTS: Among 115 patients included in the analysis, the mean age was 68.4±10.9 years; 17 patients (14.8%) identified as Arab, 20 patients (17.4%) identified as Asian, 36 patients (31.3%) identified as Black, and 42 (36.5%) as White. Most patients had public insurance (66.9%), and almost half lived in Wayne County (48.7%). Having public insurance (exp[β]=2.9; 95% CI, 1.08-7.75; P=0.03), residing in Wayne County (P=0.01), and being treated during the COVID-19 pandemic (exp[β]=2.9; 95% CI, 1.12-7.44; P=0.03) were associated with a longer time to surgical decision. CONCLUSIONS: Our findings suggest that certain SDoH, such as public insurance and county of residence, may influence PFD surgical decision times.