Effects of Race and Clinical Factors on Short-Term Outcomes of Abdominal Myomectomy Ted M. Roth, MD, Tara Gustilo-Ashby, MD, MPH, Matthew D. Barber, MD, MHS, and Evan R. Myers, MD, MPH 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 opera- tive 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 per- cent had comorbidities. Twenty percent required transfu- sion. 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 complica- tions (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 leiomy- omata at the time of presentation for surgery. (Obstet Gynecol 2003;101:881– 4. © 2003 by The American College of Obstetricians and Gynecologists.) The incidence of uterine leiomyomata is 25– 40% of women in their childbearing years. 1 Black women are at particularly high risk for leiomyomata compared with women of other races. In the Nurse’s Health Study, the incidence among black women was approximately three times that among white women, with diagnosis at an earlier age. 2 Black women undergoing hysterec- tomy for leiomyomata are younger, have more nu- merous leiomyomata, and larger uterine size com- pared with white women. 3,4 Higher hysterectomy rates and higher in-hospital mortality rates have been reported for black women in comparison with white women. 5 In one study, 30% of black women who underwent hysterectomy had uteri greater than 500 g versus only 15% of white women. 3 The study by Hillis et al demon- strated that women undergoing hysterectomy with a uterus greater than 500 g were 1.6 times (95% confidence interval [CI] 1.0, 4.0) more likely to develop operative or postoperative complications, specifically cuff cellulitis and transfusion. 4 These observations suggest that much of the excess risk of complications in black women may be attributed to increased uterine size, but we are un- aware of any studies that have analyzed complication rates by both uterine size and race. There are no studies of risk of complications for hysterectomies performed specifically for leiomyomata, and information on surgical procedures in minority women historically has been inadequate. There is even less information available on racial differences in compli- cations of myomectomy. We examined the potential relationships between race, uterine anatomy, and com- plications of myomectomy by using logistic regression to determine if complication rates for black and white women differed after statistical adjustment for uterine anatomy and other comorbidities. 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. This article is based on research conducted by Duke University under contract with the Agency for Healthcare Research and Quality (contract no. 290-97-0014). The authors are solely responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the United States Department of Health and Human Services. 881 VOL. 101, NO. 5, PART 1, MAY 2003 0029-7844/03/$30.00 © 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier. doi:10.1016/S0029-7844(03)00015-2