Myomectomy Trends in a Population-Based Cohort from 2005-2018

Abstract

Study Objective To analyze trends in operative approach for myomectomy (open vs. minimally invasive myomectomy, MIM), as well as identify patient and facility factors associated with approach. Design Population based cohort study. Setting All non-VA Facilities in the state of California from 01/01/2005 through 12/31/2018. Patients or Participants Women undergoing myomectomy in California from 01/01/2005-12/31/2018 were identified from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 diagnosis codes and CPT procedure codes. Interventions Demographics, facility of surgery and surgical approach were identified. Univariate (chi-square, t-test) and Multivariate (logistic regression) associations were explored between the above factors and rates of a minimally invasive (vs. open) approach. Given that the minimally invasive approach was used only rarely prior to 2012, this comparative analysis included only patients who had their surgery after 01/01/2012. Measurements and Main Results Of the 71,747 cases of myomectomy identified, 10,708 (14.9%) were MIM. Although the annual number of myomectomies was consistent between years (mean 5,125 annually), there was an increase in MIM (3.7%, 14.7% and 38.9% of cases in years 2005, 2012 and 2018, respectively). Multivariate analysis revealed that, compared to White women, Black and Hispanic women were less likely to have MIM (OR 0.88, p<0.001, OR 0.74, 95% CI 0.69-0.79, p<0.001 respectively). Compared to the Privately insured, Medicaid payor status was associated with decreased rates of MIM (OR 0.22, p<0.001). Surgery at an Academic center was independently associated with higher rates of MIM (OR 1.50, p<0.001). Conclusion The proportion of myomectomies performed via a minimally invasive approach is increasing. However, certain patient populations (racial minorities, those with Medicaid, and those undergoing care at non-academic facilities) were less likely to undergo MIM. This suggests that disparities in the care for women with fibroid disease exist, and that future efforts need to focus on reducing the lack of access to MIM for underserved populations. To analyze trends in operative approach for myomectomy (open vs. minimally invasive myomectomy, MIM), as well as identify patient and facility factors associated with approach. Population based cohort study. All non-VA Facilities in the state of California from 01/01/2005 through 12/31/2018. Women undergoing myomectomy in California from 01/01/2005-12/31/2018 were identified from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 diagnosis codes and CPT procedure codes. Demographics, facility of surgery and surgical approach were identified. Univariate (chi-square, t-test) and Multivariate (logistic regression) associations were explored between the above factors and rates of a minimally invasive (vs. open) approach. Given that the minimally invasive approach was used only rarely prior to 2012, this comparative analysis included only patients who had their surgery after 01/01/2012. Of the 71,747 cases of myomectomy identified, 10,708 (14.9%) were MIM. Although the annual number of myomectomies was consistent between years (mean 5,125 annually), there was an increase in MIM (3.7%, 14.7% and 38.9% of cases in years 2005, 2012 and 2018, respectively). Multivariate analysis revealed that, compared to White women, Black and Hispanic women were less likely to have MIM (OR 0.88, p<0.001, OR 0.74, 95% CI 0.69-0.79, p<0.001 respectively). Compared to the Privately insured, Medicaid payor status was associated with decreased rates of MIM (OR 0.22, p<0.001). Surgery at an Academic center was independently associated with higher rates of MIM (OR 1.50, p<0.001). The proportion of myomectomies performed via a minimally invasive approach is increasing. However, certain patient populations (racial minorities, those with Medicaid, and those undergoing care at non-academic facilities) were less likely to undergo MIM. This suggests that disparities in the care for women with fibroid disease exist, and that future efforts need to focus on reducing the lack of access to MIM for underserved populations.