Laparoscopic Versus Abdominal Myomectomy: Practice Patterns and Health Care Use in British Columbia |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON;2. School of Population and Public Health, University of British Columbia, Vancouver BC;3. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC;1. School of Public Health, Fudan University, Shanghai, China;2. Fetal Medicine Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China;3. OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa ON;4. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa ON;5. Placenta Clinic, Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto ON;6. Department of Epidemiology, Biostatistics and Occupational Health and Department of Pediatrics, McGill University Faculty of Medicine, Montreal QC;7. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ottawa General Hospital, University of Ottawa, Ottawa ON;8. Shanghai Institute of Planned Parenthood Research/WHO Collaborating Center on Human Research, Shanghai, China;1. Department of Obstetrics and Gynaecology, The Ottawa Hospital, Ottawa ON;2. Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON;3. Ottawa Hospital Research Institute, Ottawa ON;1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis IN;2. Department of Obstetrics and Gynecology, Assiut University, Egypt;3. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis IN;4. Reproductive Medicine, American Health Network, Indianapolis IN;5. Institute of Reproductive and Developmental Biology, Imperial College, London, UK |
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| Abstract: | ![]()
ObjectiveTo examine the relative frequency and surgical outcomes of laparoscopic myomectomy compared with abdominal myomectomy in British Columbia.MethodsA linked database containing hospital admission, operating room, and emergency room data from 2007 to 2011 from eight Vancouver Coastal Health and Providence Health Region hospitals in British Columbia was used to conduct a retrospective cohort study of women who had myomectomy for uterine fibroids. All consecutive women who had abdominal or laparoscopic myomectomy at five hospitals were included in the study. Patients who had submucosal fibroids or hysteroscopic procedures were excluded. Abdominal and laparoscopic myomectomies were contrasted in terms of patient characteristics and surgical outcomes. Statistical significance was assessed using t tests, Wilcoxon, chi-square, and Fisher exact test; a two-sided P value < 0.05 was considered significant.ResultsOf eight hospitals offering gynaecologic surgery, myomectomies were performed at five hospitals located in metropolitan areas. Of 436 women undergoing myomectomy, 88 cases (20.2%) were laparoscopic, 342 (78.4%) were abdominal, and 6 (1.38%) were laparoscopic with conversion to laparotomy. Women who had laparoscopic rather than abdominal myomectomies were slightly older (mean 38.7 vs. 37.4 years, respectively, P < 0.05). No significant difference was observed in median operative time (106 vs. 95 min), but length of stay was decreased for laparoscopic myomectomies (median 1 vs. 2 days, P < 0.01). No significant differences were observed between laparoscopic and abdominal routes in the rates of admission to intensive care, prolonged hospitalization (> 3 days), or rehospitalization.ConclusionMyomectomies are performed in urban, metropolitan areas in British Columbia, and a significant fraction of myomectomies are performed by laparoscopy. Compared with abdominal myomectomies, laparoscopic myomectomies in pre-selected patients are associated with decreased length of stay and comparable perioperative surgical outcomes. |
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