Racial and Ethnic Differences in Patients Who Underwent A Myomectomy or Hysterectomy in 2022

INTRODUCTION: Non-Hispanic Black women are 2–3 times more likely to have fibroids compared to non-Hispanic White women (1). Black women report more severe symptoms such as heavy bleeding and are also found to have larger uterine volumes at the time of diagnosis (2). There are various treatment options for leiomyomas, and the surgical options include myomectomy and hysterectomy. Goals of treatment for either option are often based on future fertility, as well as primary presenting symptoms. As age increases, fertility decreases (3). Therefore, it is expected that with the decline in fertility, there is also a decline in myomectomy rates. There is inconclusive evidence regarding racial differences between uterine sparing and definitive surgery for uterine fibroids. Some studies show that Black women are more likely to receive hysterectomies, whereas others show that Black women with uterine fibroids are more likely to opt for a uterine-preserving surgery. OBJECTIVE: Our objective was to determine whether race and ethnicity affect the expected decrease in myomectomy rates associated with the decline in fertility rates with advancing age. METHODS: 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. This study included 23,478 women. 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. 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) (Table 1). 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 (Table 2). 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 (Figure 1). CONCLUSIONS: 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.