Disparities in Minimally Invasive Myomectomy When Matched for Fibroid Burden

Abstract

Study Objective To identify whether disparities persist between route of myomectomy when matching African American and Caucasian women for fibroid burden, using preoperative, intraoperative, and postoperative findings. Design This is a retrospective chart review of all myomectomies at a tertiary care center between 2012 and 2018. Surgical approach to myomectomy was classified as open, laparoscopic, or robotic-assisted laparoscopic. Fibroid burden was quantified preoperatively using uterine volume, intraoperatively by number of fibroids on operative report, and postoperatively by fibroid weight from pathology report. Setting A single academic center where all patients have equal access to surgeons who perform minimally invasive and open myomectomy. Patients or Participants 689 women who underwent surgical treatment of fibroids were included. Interventions n/a Measurements and Main Results African-American women had higher fibroid burden by preoperative imaging (p We then used the greedy nearest neighbor matching without replacement, within caliper width of 0.5, to match Caucasian women and African-American women by fibroid burden. Using propensity score matching for preoperative uterine volume (p=0.38), number of fibroids on operative report (p=0.84), and fibroid weight on pathology report (p=0.26), there was no statistically significant difference between African American and Caucasian women undergoing minimally invasive or open myomectomy. Conclusion In a single institution where all women have access to minimally invasive and open myomectomy, race did not affect whether women underwent an open or minimally invasive procedure when matched for fibroid burden. This finding suggests that access to minimally invasive myomectomy for women with a similar fibroid burden plays a role in the national disparity between African American and Caucasian women undergoing surgical treatment of fibroids.