A Surgical Snapshot of Myomectomies in the United States from 2010-2014 using the National Inpatient Sample

Abstract

Study Objective To examine the surgical approach to myomectomy and describe patient factors including geography, race, and length of stay. Design Data was abstracted from the 2010-2014 National Inpatient Sample of women ages 18-50 years undergoing myomectomy for fibroids. We used weighted statistics to characterize the number and proportion of women undergoing inpatient myomectomy (abdominal, laparoscopic, and robotic) as well as geographic and racial subgroups. We used multivariate logistic regression to analyze trends in myomectomy route over time. Setting United States. Patients or Participants 124,880 women ages 18-50 years undergoing inpatient myomectomy for fibroids. Interventions N/A Measurements and Main Results Of 124,880 women undergoing myomectomy for fibroids, 7% underwent minimally invasive myomectomy (MIM) and 93% underwent abdominal myomectomy. Over time, the proportion of MIM remained low and decreased slightly from 8.2% in 2010 to 6.0% in 2014 (p-for-trend: 0.001). The majority of hospitals perform very few MIM per year, with 75% performing three or fewer per year, and 25% performing less than one per year. The largest percentage of MIM were performed in the South (37.6%; 95%CI 35.4-39.8) followed by the West (22.7%; 95%CI 20.8-24.6) and North (21.8%; 95%CI 19.9-23.7) and the least amount in the Midwest (17.9%; 95%CI 16.1-19.6). The largest percentage of MIM were performed in white women (41.4%; 95%CI 39.1-43.8) followed by black (34.3%; 95%CI 32.1-36.6), Hispanic (13.6%; 95%CI 12.0-15.2) and women of other races (10.7%; 95%CI 9.2-12.1). Average length of stay regardless of approach was 2.62 days (95%CI 2.59-2.65) and marginally different for MIM versus abdominal myomectomy (2.51 days; 95%CI 2.42-2.61 and 2.63 days; 95%CI 2.60-2.66, respectively). Conclusion Despite availability and patient benefit, MIM remains an underutilized modality, accounting for