Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010-2014

This study aims to characterize the utilization of minimally invasive myomectomy in the United States and to identify the patient and hospital factors associated with surgical approach to myomectomy.

This is a cross-sectional study using the National Inpatient Sample database. We extracted women aged 18-50 years who underwent open and minimally invasive (laparoscopic and robotic) myomectomy (MIM) from January 1, 2010-December 31, 2014. Descriptive statistics were obtained for patient and hospital characteristics. We then performed multivariable logistic regression to examine the association of patient (age, race, insurance status, median household income) and hospital (bed size, teaching status, for-profit status, census region, cases volume) characteristics with the likelihood of undergoing MIM.

Of 114,850 myomectomy cases, 8,330 (7%) underwent MIM and 106,520 (93%) were open. Over time, the proportion of MIM remained very low and slightly decreased from 8.2% in 2010 to 6.1% in 2014 (p-for-trend: 0.001). Most hospitals performed few MIM per year, with 50% performing five or less, and 25% performing three or fewer per year. African American, Hispanic, and women of other races were less likely to undergo MIM compared to Caucasian women (adjusted odds ration [OR] 0.57, 95% confidence interval [CI] 0.50-0.64; 0.71, 95% CI 0.60-0.83; 0.62, 95% CI 0.52-0.74, respectively). Women in the West (adjusted odds ratio (aOR) 1.23, 95% CI 1.04-1.46) and Midwest (aOR 1.27, 95% CI 1.07-1.52) had higher odds of undergoing MIM.

MIM appears to be an underutilized modality, accounting for less than10% of myomectomies. This underutilization disproportionally affects minority women.