Introduction

Emerging evidence suggests that there may be disparity concerning Women’s Health outcomes relating to ethnicity in the US. This is particularly concerning given that Black women suffer disproportionately from uterine fibroids. To date, there has been limited study regarding the impact of ethnicity on post-surgical outcomes after myomectomy.

Aims

The purpose of this study was to examine the impact of ethnicity on surgical route and reintervention outcomes post-myomectomy in England.

Methods

Retrospective, national population-based, cohort study utilising Hospital Episode Statistics(HES) data

Cohort determined based on HES dataset extract

Inclusion criteria: Patients were identified in the HES Admitted Patient Care dataset between 2010 and 2015 that underwent myomectomy in England under the NHS

Exclusion criteria: Women who were aged less than 18 years; underwent a non-elective procedure; were coded as having a hysterectomy during the encounter of their index procedure

All encounters linked relating to an individual cohort member using HESID until end of study. After the index treatment, all subsequent encounters scrutinised for the presence of reintervention OPCS4 procedural codes until the end of study.  Patients undergoing hysterectomy or Uterine-preserving procedure (UPP) reinterventions contributed person-time to the study until first occurrence of either hysterectomy or UPP reintervention, death, or end of study (31st March 2020). 

Primary outcome(s): UPP and hysterectomy reinterventions rates after index myomectomy

UPP reintervention included only myomectomy, uterine artery embolization, endometrial ablation, or MR guided focused ultrasound procedures

Chi-squared test was used to compare categorical variables. Binary logistic regression was used to provide an estimate of the crude risk for laparoscopic approach after myomectomy. Cox’s proportional-hazards regression model was used to provide an estimate of the crude risk for hysterectomy or UPP reintervention after index treatment for myomectomy.

Adjusted risk was conditioned on case-mix covariates that included: age, geographical region, comorbidities, and index of multiple deprivation.

British (White) women were the reference(comparator) group for minoritized groups because of the potential influence of unconscious bias.

Results

There were 9443 myomectomies undertaken over 5 years

Odds ratios are plotted below for laparoscopic approach, hysterectomy reintervention and uterine-preserving procedure reintervention outcomes.