title: Laparoscopic versus abdominal myomectomy: practice patterns and health care use in British Columbia.
abstract: OBJECTIVE
  To examine the relative frequency and surgical outcomes of laparoscopic myomectomy compared with abdominal myomectomy in British Columbia.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  Myomectomies 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; School of Population and Public Health, University of British Columbia, Vancouver BC.
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Sarka
authors.initials: S
authors.lastname: Lisonkova
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Christina
authors.initials: C
authors.lastname: Williams
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Paul
authors.initials: P
authors.lastname: Yong
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Catherine
authors.initials: C
authors.lastname: Allaire
mesh_terms: D000328:Adult; D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data; D007889:Leiomyoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods / Q000706:statistics & numerical data; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery
keywords: health care use; laparoscopy; myomectomy; practice pattern