Socioeconomic, Demographic, and Surgeon Factors Associated With Staged Versus Concomitant Surgery for Pelvic Organ Prolapse and Stress Urinary Incontinence
Notice bibliographique
Résumé
INTRODUCTION: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) frequently coexist, and de novo SUI following POP treatment is commonly taken into consideration during surgical planning. While concomitant surgery for POP and SUI may benefit patients, literature suggests a variety of treatment algorithms and clinical application of this data often differs amongst providers. Therefore, it is possible that shared decision making for these complex options may be impacted by language, educational, or other socioeconomic factors. OBJECTIVE: This study examines patient-, location-, and surgeon-level factors associated with staged versus concomitant stress urinary incontinence surgery among U.S. female Medicare patients undergoing surgery for POP. METHODS: The 100% Medicare Standard Analytical Files were used to identify female patients treated surgically for POP between 2016 and 2020. The study included patients who had concomitant midurethral sling (MUS) procedure and those who had a staged procedure defined as MUS within 24 months following POP procedure. Multivariable logistic regression was used to assess the association between patient, location, and surgeon-level factors and the likelihood of staged versus concomitant procedures. Patient-level factors included race, region, and urbanization. Location-level factors were county-level characteristics from the Agency for Healthcare Research and Quality Social Determinants of Health Database 2019, including per capita income, proportion of foreign-born, and proportion of limited English-speaking households. The specialty of the surgeon who performed the POP procedure (urology, obstetrics/gynecology (OBGYN), or other) was used to characterize surgeon-level factors. RESULTS: Among 40,842 patients who had POP procedures between 2016 and 2020, 96.7% (39,440) had a concomitant procedure and 3.4% (1,402) had a staged procedure. Caucasian patients (3.5% vs. 1.2% for Asian, p=0.036), patients living in urban areas (3.5% vs. 3.2% for rural areas, p=0.05) and in the Southern region of the US (3.9% vs. 2.5% Northeastern, p<0.001) were more likely to undergo staged procedures. Patients from counties with lower per-capita income (p=0.001), a lower proportion of foreign-born (p=0.003), and a lower proportion of limited English-speaking households (p=0.002) were more likely to receive staged procedures. Patients whose POP procedure was performed by OBGYNs were more likely to receive staged procedures than those performed by urologists. CONCLUSIONS: Our analysis identified both socioeconomic and surgeon factors associated with staged versus concomitant MUS procedures among patients undergoing surgical treatment for POP. It is not clear if these differences are attributable to inequities in care or other factors. Future studies should endeavor to understand how these socioeconomic and surgeon characteristics impact the decision to undergo a concomitant vs. staged MUS procedure.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».