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Keywords

Distance traveled; Healthcare disparities; Patient choices; Pelvic organ prolapse; Stress urinary incontinence

Abstract

OBJECTIVES: To determine if distance traveled for care influenced patient choice for conservative vs. surgical treatment for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI).

METHODS: Retrospective chart review of all new patients seen in the Urogynecology clinic at the University of New Mexico Hospital (UNMH) from January 2007 through September 2011. Data collected included medical history, Pelvic Organ Prolapse Quantification (POPQ) examination, and validated quality of life questionnaires.

RESULTS: 1384 women were identified with POP and/or SUI. Women traveled an average of 50 miles to receive care at UNMH. After multivariable analysis, greater distance traveled was associated with increased likelihood of choosing surgery, OR 1.45 [1.18-1.76]. More advanced disease as measured by higher stage of prolapse, OR 3.43 [2.30-5.11], and positive leak with empty supine cough test, OR 1.94 [1.45-2.59] were also associated with choosing surgical management.

CONCLUSIONS: Women who travel further for care and women with more advanced pelvic organ prolapse and/or stress urinary incontinence are more likely to choose surgical management for pelvic floor disorders.

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