8760 Racial and Ethnic Disparities in Utilization of Laparoscopic Myomectomy

Abstract

<h3>Study Objective</h3> When feasible, laparoscopic myomectomy has superior outcomes, including complication risk, recovery time and patient satisfaction, compared to open surgery. A few studies have shown mode of surgery for myomectomy to be influenced by a patient's race; we sought to further explore this association. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> 722 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. <h3>Patients or Participants</h3> Patients undergoing myomectomy from 2014-2020. <h3>Interventions</h3> Patients undergoing laparoscopic or open myomectomy were identified by CPT code. We used log-binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI). <h3>Measurements and Main Results</h3> Among 24,416 patients, 25.0% were white, 40.6% Black, 9.9% Hispanic and 24.4% other/unknown race or ethnicity. White patients had a higher proportion of laparoscopic myomectomy (58.5%) than open myomectomy (41.5%), but all other racial and ethnic groups more frequently had open surgery (64.7% Black, 60.3% other/unknown, 52.9% Hispanic). All other racial and ethnic groups were significantly more likely than white patients to undergo open myomectomy (Black RR 1.56 [95% CI 1.51-1.61], other/unknown RR 1.45 [95% CI 1.40-1.50], Hispanic RR 1.27 [95% CI 1.21-1.34]). The RRs were essentially unchanged when controlling for patient factors that could influence route of myomectomy, such as age, BMI, medical comorbidities, and smoking. Even within the same procedure type, race was associated with risk of complications. Among laparoscopic myomectomies, Black patients were significantly more likely than white patients to have surgical morbidity (5.1% vs 3.0%, p<.0001); among open myomectomies, Black patients were significantly more likely than white patients to have both medical (1.1% vs 0.4%, p = 0.001) and surgical morbidity (19.9% vs 9.0%, p<.0001). <h3>Conclusion</h3> Race and ethnicity were associated with differences in route of myomectomy and risk of complications. Influencing factors could involve both fibroid burden and social determinants of health, including racism.