Predictors of Surgical Approach to Myomectomies by Race

Abstract

Study Objective To analyze patient and hospital characteristics, stratified by race, 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 trends in minimally-invasive (laparoscopic and robotic) by patient factors (age, insurance, and income subgroups) and hospital factors (teaching status, for-profit status, size) and stratified by race (White, Black, Hispanic). 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. Black women had a total of 55,960 myomectomies performed of which 3,360 (6.0%) were MIM. Black women had lower odds of undergoing MIM at teaching hospitals [OR.79 95%CI.64-.96] and in the highest income bracket [OR.69 95%CI.54-.89]. White women had a total of 39,560 myomectomies performed of which 4,870 (12.3%) were MIM. White women had lower odds of having MIM with private insurance [OR.75 95%CI.60-.93], highest income bracket [OR.71 95%CI.55-.92], at large hospitals [OR.822 95%CI.69-.97], or at teaching hospitals [OR.66 95%CI.56-.79]. Hispanic women had a total of 15,930 myomectomies performed of which 1,140 (7.2%) were MIM. Hispanic women had lower odds of undergoing MIM at for-profit hospitals [OR.62 95%CI.39-.97]. Across all races, women ages 41-50 were more likely to have MIM [White OR 6.5 95%CI 4.73- 8.96, Black OR 2.6 95%CI 1.98-3.44, Hispanic OR 3.73 95%CI 2.28-6.08]. Conclusion Racial disparities exist with access to MIM. Black women undergo the majority of myomectomies, but only 6% are minimally invasive compared to white women (12.3%).