Racial Disparities in Abdominal and Laparoscopic Myomectomies: A NSQIP Study

Study Objective

Identify disparities in myomectomy approach and outcomes for black and non-black patients.

Design

Retrospective analysis of benign myomectomy procedures, categorized into "abdominal" and "laparoscopic" based on Current Procedural Terminology (CPT) codes. Patient race, comorbid conditions, and postoperative outcomes were compared using univariate and multivariate analyses.

Setting

Analysis of American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Patients or Participants

Patients undergoing abdominal or laparoscopic myomectomy from 2018 to 2020.

Interventions

N/A.

Measurements and Main Results

A total of 12,370 cases were identified as abdominal or laparoscopic myomectomies. 56% were abdominal and the remaining 44% were laparoscopic. Black patients accounted for 40% of all myomectomies, while white patients accounted for 29%. Black patients had a 65% increased odds of an abdominal approach compared to white patients (OR 1.65, 95% CI 1.51-1.81), and a 27% increased odds compared to all non-black patients (OR 1.27, 95% CI 1.18-1.36). Black patients were more likely to have BMI ≥ 25 (p<0.001), 5 or more fibroids/size > 250g (p<0.001), hypertension requiring medications (p<0.001), need inpatient admission (p<0.001), have preoperative anemia (p<0.001), and receive a preoperative transfusion (p<0.001). After controlling for fibroid size and number, black patients were still 40% more likely to undergo an abdominal approach than non-black patients. Additionally, although overall rare, black patients were more likely to experience postoperative complications. They were more likely to require postoperative transfusion, even after adjusting for preoperative anemia, myomectomy route, and number/size of fibroids removed (OR 1.6, 95% CI 1.3-1.8). They were also more likely to have a pulmonary embolism (p=0.03) and hospital stays greater than 1 day (p=0.06) after an abdominal myomectomy, though these differences were not present for laparoscopy.

Conclusion

Black patients are more likely to undergo abdominal myomectomies and have postoperative complications than non-black patients. These disparities persist after controlling for preoperative risk factors and are not solely attributable to surgical route.