Predictors of Surgical Approach to Myomectomies by Geographic Location

Abstract

Study Objective To analyze patient and hospital characteristics, stratified by geographic location, among women undergoing minimally invasive and abdominal myomectomies. Design Data was abstracted from the 2010-2014 National Inpatient Sample of women ages 18-50 years undergoing myomectomy for fibroids. We used a multivariate logistic regression to analyze temporal and geographic trends in minimally-invasive (laparoscopic and robotic) and abdominal myomectomy by patient factors (age, race, insurance, income subgroups) and hospital characteristics (teaching status, for-profit status, size). 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 the 124,880 women undergoing myomectomy for fibroids, 7% underwent minimally invasive myomectomy (MIM) and 93% underwent abdominal myomectomy. The percentage of MIM by geographic region was: South 37.6%, West 22.7%, North 21.8%, and Midwest 17.9%. In all geographic regions, women aged 41-50 had higher odds of undergoing MIM compared to younger women [North OR 2.21 95%CI 1.57 – 3.12, South OR 4.15 95%CI 3.14 – 5.50, Midwest OR 7.25 95%CI 4.36 – 12.05, West OR 4.57 95%CI 3.00- 6.96]. White women also had higher odds of undergoing MIM in the North, South, and West compared to women of other races [North OR 1.53 95%CI 1.08-2.17, South OR 1.51 95%CI 1.09-2.10, West OR 1.83 95%CI 1.32-2.54]. In the South, West, and Midwest, teaching hospitals had lower odds of performing MIM [South OR 0.71 95%CI .60- .85, Midwest OR .57 95%CI .43-.77, West OR .76 95%CI .60-.95]. Large hospitals in the North and West had lower odds of performing MIM [North OR 0.77 95%CI .62-.97, West OR .76 95%CI .60-.95]. Conclusion Utilization of MIM is low throughout the US with further regional and age disparities. MIM is more likely to be performed in older aged women and in the South.