Travel Time and Treatment Choice in Pelvic Organ Prolapse.

IMPORTANCE: Demographic shifts within the United States have led to an increased proportion of older adults living in rural areas, which brings additional challenges to accessing urogynecologic care. As a rural tertiary care center, we sought to explore how travel time affects a patient's treatment choice for pelvic organ prolapse. OBJECTIVES: The objective of this study was to assess if patient choice of conservative versus surgical treatment of pelvic organ prolapse differs across travel time and whether travel time affects the decision to transition to surgery among patients who initially opted for pessary treatment. STUDY DESIGN: We conducted a retrospective cohort study of 1,511 patients diagnosed with pelvic organ prolapse who were seen at a single institution between October 2015 and December 2023. We examined initial treatment choice at baseline for the full cohort, and subsequent conversion to surgical management for those who initially chose pessary care. Travel time was calculated with geospatial mapping to the patient's census tract. RESULTS: Of the 1,511 patients included, 598 (39.6%) deferred treatment, 360 (23.8%) initially chose pessary care, and 553 (36.7%) underwent surgical management. For patients who chose treatment, longer travel times were significantly associated with higher odds of selecting surgical treatment over pessary care, even after multivariable adjustment (P-trend <0.0001). Travel time was not associated with conversion to surgical management from pessary care (P value = 0.84). CONCLUSIONS: In this cohort of patients with pelvic organ prolapse who elected for treatment, longer travel times were associated with an increased likelihood of selecting surgical treatment over pessary care.