Investigate potential racial/socioeconomic disparities in access to minimally invasive myomectomy (MIM).

Design:

Retrospective cohort study.

Setting:

Large academic hospital.

Patients or Participants:

Women undergoing myomectomy for benign leiomyomata between 2016 and 2022. Cases involving previous hysterectomy, preoperative leiomyosarcoma diagnosis, hysteroscopic myomectomy, emergency myomectomy, or missing race/ethnicity data were excluded.

Interventions: MIM ((hand-assisted) laparoscopic or robotic) and abdominal myomectomy (AM).

Measurements and Main Results:

1243 cases were identified. Racial/ethnic composition was 44.5% White, 38.8% Black, 7.3% Hispanic, and 9.4% Asian. 830 (66.8%) of cases were MIM and 413 (33.2%) AM. MIM rate was highest in the White group (77.6%) and lowest in the Black group (53.5%). Black women had highest BMI (mean 29.4±6.4 kg/m²), prior surgery rate (45.0%), fibroid weight (median 278; IQR 142-561 grams), and number of fibroids (median 8; IQR 3-17). In our regression analysis we sought to control for both fibroid weight and number, somewhat collinear variables affecting clinical decision making. When we added both variables along with other potential confounders to a regression model, there were no significant racial disparities in access to MIM (aOR 0.96, 95% CI 0.72-1.28). A regression with weight but not number showed persistence of disparities (aOR 0.58, 95% CI 0.45-0.75), while one with number not weight showed resolution of disparities (aOR 0.90, 95% CI 0.68-1.18). Social vulnerability index (SVI) did not significantly change outcomes upon incorporation into the regression model.

Conclusion:

Within our hospital, disparities exist as Black women have less access to MIM compared to White. Black women had higher fibroid weights and more fibroids which greatly influenced surgery route, and when both factors were added to regression analysis, disparities nullified. In contrast to our hysterectomy disparities study, SVI did not influence outcomes. Our results may reflect delays in care. Future studies and stakeholder meetings will focus on ensuring earlier recognition and surgery referral.