Socioeconomic, Demographic, and Provider Determinants of Staged Versus Concomitant Surgery for Pelvic Organ Prolapse and Stress Urinary Incontinence
Bibliographic record
Abstract
Background: While concomitant surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) may benefit patients, variability exists in practice. A better understanding of the decision-making process regarding the placement of mid-urethral slings (MUSs) in women undergoing POP surgery is crucial for achieving equitable surgical planning and patient counselling. This study assessed factors associated with staged vs. concomitant SUI surgery in patients undergoing POP surgery. Methods: This retrospective cohort study used 100% Medicare Standard Analytical Files from 2016 to 2020. The sample population consisted of female patients surgically treated for POP with staged (within 24 months) or concomitant mid-urethral sling (MUS). Data were merged with the Agency for Healthcare Research and Quality (AHRQ) Social Determinants of Health Database. Multivariable logistic regression was used to assess independent associations between patient, location, and surgeon characteristics and the likelihood of staged versus concomitant procedures. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: Among 40,842 patients with POP surgery, 96.7% (39,440) had concomitant, while 3.4% (1,402) had staged MUS. Most were aged 65 - 74 years (67.2%), Caucasian (91.7%), from urban areas (91.9%), and had Charlson Comorbidity Index ≤ 3 (82.3%). A higher likelihood of staged surgery was seen in White vs. other racial groups (example OR: 1.50 vs. Black, 95% CI: 1.03 - 2.18); in the South vs. other regions (example OR: 1.55 vs. Northeast, 95% CI: 1.26 - 1.91); and for obstetrics/gynecology vs. urologic surgeons (OR: 1.19, 95% CI: 1.02 - 1.40). Patients in counties with lower per capita income (OR: 1.02, 95% CI: 1.01 - 1.03), lower proportions of foreign-born (OR: 1.01, 95% CI: 1.01 - 1.05), limited English-speaking (OR: 1.03, 95% CI: 1.01 - 1.05), or uninsured (< 64 years of age; OR: 1.02, 95% CI: 1.00 - 1.03) households had higher likelihood of receiving staged surgery. Conclusions: This study identified several demographic, socioeconomic, and surgeon-related factors associated with staged vs. concomitant MUS procedures among patients undergoing surgery for POP. The reasons for these differences are not fully understood and may reflect various underlying factors, including differences in communication, regional or specialty norms, patient choice, or other factors.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".