Design: This was a cross-sectional study using the American College of Surgeons NSQIP and NSQIP Procedure Targeted Data Files for patients who underwent benign myomectomy or hysterectomy in 2022. The primary exposure of interest was patient race and ethnicity. Age was controlled by stratification. Unadjusted odds ratios and confidence intervals were calculated to identify factors predicting the performance of a myomectomy versus hysterectomy during univariate analysis (p < 0.05). Adjusted odds ratios and confidence intervals were calculated during parsimonious hierarchical logistic regression analysis to control for potential confounders of the relationship between race/ethnicity and treatment choice for each age stratification group. IBM SPSS Statistics was used for all data analysis.

Setting: This study was conducted with data from the NSQIP database.

Patients or Participants: This study included 23,478 women who underwent a benign myomectomy or hysterectomy in 2022

Interventions: None

Measurements and Main Results: Age, BMI, parity, race and ethnicity, diabetes, pelvic inflammatory disease, prior pelvic surgery, prior abdominal surgery, and endometriosis all predicted treatment choice during univariate analysis and were included in the logistic regression analysis for each age stratification group (p <0.001). Race and ethnicity were found to independently predict myomectomy instead of a hysterectomy at each age stratification group (p < 0.001) after controlling for confounders identified during univariate analysis. Compared to non-Hispanic white patients who had a decreasing likelihood of myomectomy with increasing age, other race/ethnicity groups were less likely to undergo a hysterectomy.

Conclusion: As non-Hispanic white women get older, the likelihood of myomectomy decreases. This trend is less pronounced with patients from other race and ethnic backgrounds. This preference for uterine preservation persists despite known decreases in fertility with advancing age. There are likely other cultural, socioeconomic, and historical factors affecting choice of procedure.