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ORIGINAL RESEARCH |
From the Division of Gynecology, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi; Indian Health Service, Chinle, New Mexico; Division of Urogynecology, Department of Obstetrics and Gynecology, The Cleveland Clinic Hospitals, Cleveland, Ohio; and Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Address reprint requests to: Ted M. Roth, MD, Division of Gynecology, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39211; E-mail: timbukted{at}yahoo.com.
OBJECTIVE: To estimate the effects of race and preoperative uterine anatomy on complication rates after myomectomy.
METHODS: A total of 239 abdominal myomectomies were performed at Duke University Medical Center from July 1992 through June 1998. Charts were abstracted using standardized forms. We assessed patient characteristics, surgical indications, preoperative hematocrit, and operative findings. Outcomes were defined as any complication, including transfusion.
RESULTS: The population (n = 225) was 53% black and 47% white. The mean body mass index was 26. Fourteen percent had comorbidities. Twenty percent required transfusion. Black women were found to be more likely to have uteri with more than four leiomyomata and less likely to have only one leiomyoma (P = .001). Black women were 2.48 times more likely to have a complication (P < .006). Race was no longer a significant predictor for complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 0.56, 3.15) after adjustment for uterine size (OR 1.86, 95% CI 1.3, 2.67), number of leiomyomata (OR 1.83, 95% CI 1.1, 3.14), and comorbidities (OR 2.77, 95% CI 1.1, 7.69). A similar pattern was seen for blood transfusion.
CONCLUSION: Black women undergoing myomectomy are more than twice as likely to have in-hospital complication or blood transfusion than white women. This is largely attributable to differences in uterine size and leiomyoma number. Research is needed to explore why black women are more likely to have larger and more numerous leiomyomata at the time of presentation for surgery.
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