Racial and Ethnic Disparities in Surgical Timing and Preoperative Care for Urinary Incontinence: a Large Single Academic Institution Study in the USA

Introduction and Hypothesis This retrospective cohort study examined racial/ethnic differences in time from initial presentation with urinary incontinence (UI) to surgery and number of clinical visits prior to sling surgery for UI. Methods Electronic health records were accessed for patients aged 18 years or older who underwent sling procedures for UI over a 134-month period at a single academic institution. The primary outcome was lead time to surgery (LTTS), the number of days between the first clinical visit for UI and the anti-incontinence surgery. The secondary outcome was the number of UI-related clinical visits prior to surgery. ANOVA and multivariable linear regression analyses were used to identify independent predictors. Results A total of 4246 patients were analyzed. On univariate analysis, Black patients had the longest LTTS (462.8 ± 735.7 days) compared with white patients (302.2 ± 496.8 days) and “Other” patients (226.4 ± 429.4 days; p < 0.01). However, multivariable regression revealed that racial/ethnic differences in LTTS were not statistically significant after controlling for confounders (β = 11.13, p = 0.41). Instead, age and UI severity were identified as significant predictors of LTTS. Age was inversely associated with LTTS (β = −2.53, p < 0.02), and greater UI severity was associated with shorter LTTS (β = −21.93, p = 0.03). Notably, racial/ethnic differences in preoperative visit frequency remained significant in adjusted models; Asian and Hispanic patients had, on average, 0.90 ( p < 0.01) and 0.58 ( p < 0.01) more visits respectively than white patients. Conclusions Although lead time to UI surgery did not differ by race/ethnicity after adjustment, Asian and Hispanic patients had significantly more preoperative visits prior to surgery.