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Association of Patient Race With Surgical Practice and Perioperative Morbidity After Myomectomy

Stentz, Natalie C., MD; Cooney, Laura G., MD; Sammel, Mary D., ScD; Shah, Divya K., MD, MME

doi: 10.1097/AOG.0000000000002738
Contents: Gynecologic Surgery: Original Research

OBJECTIVE: To compare surgical approach, operative time, and perioperative morbidity after myomectomy by patient race.

METHODS: In this retrospective cohort study, data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database on 8,438 women undergoing myomectomy between January 1, 2012, and December 31, 2015. Myoma burden and approach to myomectomy were determined based on Current Procedural Terminology coding. Surgical approach and perioperative morbidity were examined in African American, Asian American, and Hispanic American women using non-Hispanic Caucasian women as the referent population. Adjusted means and odds ratios (ORs) with 95% CI were calculated using propensity score matching accounting for age, ethnicity, body mass index (BMI), myoma burden, preoperative anemia, hypertension, smoking, and operative time.

RESULTS: Data were available for 2,533 Caucasian, 3,359 African American, 664 Asian American, and 700 Hispanic American women. Smoking, BMI, hypertension, myoma burden, and anemia varied by race (P<.001, all comparisons). In adjusted analysis, African American women were twice as likely to undergo abdominal myomectomy (adjusted OR 1.9, 95% CI 1.7–2.0), Asian American women were more than twice as likely (adjusted OR 2.3, 95% CI 1.8–2.8), and Hispanic American women were 50% more likely to undergo abdominal myomectomy (adjusted OR 1.5, 95% CI 1.2–1.9) when compared with Caucasian women. African American women were 50% more likely to experience composite morbidity after abdominal myomectomy (adjusted OR 1.5, 95% CI 1.2–1.7) and Asian American women were more than three times as likely to experience composite morbidity after laparoscopic myomectomy (adjusted OR 3.7, 95% CI 1.7–8.1) compared with Caucasian women. There were no differences in composite morbidity in other racial groups.

CONCLUSION: Minority women are substantially more likely to undergo abdominal myomectomy when compared with Caucasian women. African American women had 50% increased odds of morbidity after abdominal myomectomy, and Asian American women were more than three times as likely to experience morbidity after laparoscopic myomectomy. Further examination into the etiology and prevention of these racial disparities is needed.

Minority women are more likely to undergo abdominal myomectomy and experience disparate postoperative morbidity when compared with non-Hispanic Caucasian women.

University of Pennsylvania, Philadelphia, Pennsylvania; and the University of Wisconsin, Madison, Wisconsin.

Corresponding author: Divya K. Shah, MD, MME, 3701 Market Street, #800, Philadelphia, PA 19104; email: Divya.Shah@uphs.upenn.edu.

Supported by National Institutes of Health 2T32HD007440-21.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the American Society for Reproductive Medicine Scientific Congress, October 28–November 1, 2017, San Antonio, Texas.

The American College of Surgeons National Surgical Quality Improvement Program and its participating hospitals are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Each author has indicated that she has met the journal's requirements for authorship.

Received March 09, 2018

Received in revised form May 04, 2018

Accepted May 17, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.