Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, the David Geffen School of Medicine at UCLA, Los Angeles, the Department of Urology, Stanford University Medical Center, Palo Alto, and the Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Obstet Gynecol. 2021 Dec 1;138(6):845-851. doi: 10.1097/AOG.0000000000004581.
To assess the association of racial and socioeconomic factors with outcomes of abdominal myomectomies.
All women undergoing abdominal myomectomy in California from 2005 to 2012 were identified from the OSHPD (Office of Statewide Health Planning and Development) using appropriate International Classification of Diseases and Current Procedural Terminology codes. Demographics, comorbidities, surgical approaches, and complications occurring within 30 days of the procedure were identified. Multivariate associations were assessed with mixed effects logistic regression models.
The cohort of 35,151 women was racially and ethnically diverse (White, 38.8%; Black, 19.9%; Hispanic, 20.3%; and Asian, 15.3%). Among all procedures, 33,906 were performed through an open abdominal approach, and 1,245 were performed using a minimally invasive approach. Proportionally, Black patients were more likely than White patients to have open procedures, and open approaches were associated with higher complication rates. Overall, 2,622 (7.5%) women suffered at least one complication. Although severe complications did not vary by race or ethnicity, Black (9.0%), Hispanic (7.9%), and Asian (7.5%) patients were more likely to suffer complications of any severity compared with White patients (6.7%, P<.001). As compared with patients with private insurance (6.4%), those with indigent payer status (Medicaid [12.1%] and self-pay [11.1%]) had higher complication rates (P<.001). Controlling for all factors, Black and Asian patients were more likely to suffer complications compared with White patients.
The overall complication rate after abdominal myomectomy was 7.5%. Comorbidities, an open approach, and indigent payer status were associated with increased complication risk. Controlling for all factors, Black and Asian patients still had increased risks of complications.
评估种族和社会经济因素与腹式子宫肌瘤切除术结果的关系。
通过适当的国际疾病分类和当前手术过程代码，从 OSHPD（州卫生规划和发展办公室）中确定 2005 年至 2012 年在加利福尼亚州接受腹式子宫肌瘤切除术的所有女性。确定了人口统计学、合并症、手术方法以及手术 30 天内发生的并发症。使用混合效应逻辑回归模型评估多变量关联。
该队列中的 35151 名女性种族和族裔多样化（白人，38.8%；黑人，19.9%；西班牙裔，20.3%；和亚洲人，15.3%）。在所有手术中，33906 例通过开放式腹部手术进行，1245 例采用微创方法进行。比例上，黑人患者比白人患者更有可能接受开放式手术，而开放式手术与更高的并发症发生率相关。总体而言，2622 名（7.5%）女性至少发生了一次并发症。尽管严重并发症与种族或族裔无关，但黑人（9.0%）、西班牙裔（7.9%）和亚洲人（7.5%）患者比白人患者（6.7%，P<.001）更有可能发生任何严重程度的并发症。与有私人保险的患者（6.4%）相比，贫困支付者（医疗补助[12.1%]和自付[11.1%]）的并发症发生率更高（P<.001）。控制所有因素后，黑人患者和亚洲患者比白人患者更有可能发生并发症。
腹式子宫肌瘤切除术后的总体并发症发生率为 7.5%。合并症、开放式手术和贫困支付者状态与并发症风险增加相关。控制所有因素后，黑人患者和亚洲患者的并发症风险仍然较高。
