ethnic differences in women’s treatment experiences with symptomatic uterine fibroids

such as fibronection (2.51+/- 0.64-fold) and collagen (4.03 +/-1.02-fold) as compared to myometrial cultures. CONCLUSION: The results demonstrated that increased stiffness of the 3D collagen scaffolds provide superior environments for the leiomyoma cells to maintain their morphology as well as exhibit cell-cell contact that is more representative of the surgical tissue. Supported by: This research was Supported by Intramural grant from Uniformed Services University of the Health Sciences, QP85GF13 and the NICHD, NIH R21, HD070152-01A1. P-450 Wednesday, October 22, 2014 GREAT EXPECTATIONS: A QUALITATIVE ASSESSMENT OF RACIAL/ETHNIC DIFFERENCES IN WOMEN’S TREATMENT EXPERIENCES WITH SYMPTOMATIC UTERINE K. S. Sengoba,a G. Mendoza,a FIBROIDS. M. S. Ghant,a A. Chaudhari,b M. Simon,c E. E. Marsh.a aObstetrics and Gynecology REI Division, Northwestern University Feinberg School of Medicine, Chicago, IL; bObstetrics and Gynecology - General, Northwestern University Feinberg School of Medicine, Chicago, IL; cObstetrics and Gynecology General/Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. OBJECTIVE: To qualitatively determine the role of race/ethnicity in women’s treatment experiences for uterine fibroids. DESIGN: Qualitative semi-structured interviews and demographic surveys. MATERIALS AND METHODS: Forty-eight women with symptomatic uterine fibroids completed interviews, surveys and a health literacy assessment. Participants were recruited from community-based organizations and an urban academic medical center. Interviews were recorded and transcribed verbatim. Data was analyzed using a grounded theory approach and through consensus, three coders identified major themes and subthemes. RESULTS: The k amongst coders was 0.94. The mean age of participants was 42.8
7.4 (mean
SD). 62.5% of subjects were African-American (AAW), 20.8% were Non-Hispanic White (WW), 10.4% were Hispanic (HW) and 6.3% were Asian (ASW). There were no significant differences in annual household income or education level across races. 90% of women expressed that they had concerns about the fibroid treatment options with which they were presented. They also, however, were concerned that they were not given all the options. When considering treatment options, AAW were more likely than WW, HW and ASW to want an intervention that was permanent and guaranteed to be successful. AAW were much more likely to demonstrate aversions toward surgery in general, toward hysterectomy specifically and toward medication than women of other racial/ethnic groups. Of the women who received a surgical intervention, AAW were also more likely to have had a difficult recovery and to be dissatisfied with their treatment. CONCLUSION: Although most women had concerns about fibroid treatment options and felt that they weren’t given all of the options, AAW were more likely to report high treatment expectations, multiple knowledge barriers that impede obtaining treatment and unsatisfactory treatment outcomes than women from other racial/ethnic groups. These data suggest that targeted patient counseling and support are critical in a diverse population. It is vital that clinicians provide accurate and comprehensive education regarding treatment options and potential outcomes for women considering interventions for their symptomatic uterine fibroids. Supported by: NIH WRHR Program K12HD050121; RWJ Foundation; NMH; Evergreen Foundation (EEM). P-451 Wednesday, October 22, 2014 CLINICAL OUTCOMES OF ROBOTIC VERSUS OPEN MYOMECTOMY PERFORMED BY ONE SURGEON. K. Van Heertum,a E. Murphy,b L. Dean,a E. Parent,a B. Marks,c S. Somkuti,a,d J. Nichols,a,d J. Schinfeld,a,d M. Sobel,a,d L. Barmat.a,d aObstetrics and Gynecology, Abington Memorial Hospital, Abington, PA; bReproductive Endocrinology and Infertility, Weill Cornell Medical College, New York, NY; c Trinity School of Medicine, Ratho Mill, Kingstown, Saint Vincent and the Grenadines; dAbington Reproductive Medicine, Abington, PA. OBJECTIVE: To compare clinical outcomes of robotic versus open myomectomy. DESIGN: Retrospective cohort study.

FERTILITY & STERILITYÒ

MATERIALS AND METHODS: Data was gathered from hospital records. A total of 235 patients who underwent myomectomy were identified: 134 robotic and 101 open. Operating room (OR) time, estimated blood loss (EBL), body mass index (BMI), fibroid number/weight, surgical complications, and length of stay (LOS) were compared. SPSS was used for stastical analysis. RESULTS: BMI was similar between the two groups. OR time was significantly longer for robotic myomectomy despite fibroid number and weight being significantly lower in the robotic group. EBL was significantly lower and LOS was significantly shorter in the robotic group. In addition, there were fewer complications in the robotic group. Greater fibroid weight was associated with longer OR time in both groups (p¼0.009 for open; p¼0.000 for robotic). Higher BMI was associated with a longer OR time in both groups (p¼0.024 for open; p¼0.024 for robotic). Greater fibroid weight was associated with a longer LOS in the robotic group only (p¼0.005). Data are reported as mean
standard deviation where appropriate and summarized in Table 1.

Table 1

2

BMI (kg/m ) OR time (hours) Fibroid number Fibroid weight (grams) EBL (mL) Complications LOS (days)

Open

Robotic

p value

27.06
5.58 1.82
0.68 5.95
5.09 364.65
548.45 215.6
294.4 20% (n¼20) 2.4
0.7

27.4
5.92 2.34
0.77 2.83
2.18 121.32
95.4 29.4
92.1 9% (n¼12) 0.1
0.31

0.659 0.000 0.000 0.000 0.000 0.014 0.000

Statistical significance defined as p<0.05 CONCLUSION: The use of robotic-assisted laparoscopy for myomectomy enables patients to undergo an outpatient procedure in place of a major abdominal surgery. While there was an increase in OR time when compared to open myomectomy, there was also significantly less blood loss and a shorter LOS in the robotic group. Additionally, there were fewer complications in the robotic group. This method appears to be an excellent alternative to traditional open myomectomy; further study is needed to assess the cost to benefit ratio of longer OR times and shorter recovery.

P-452 Wednesday, October 22, 2014 PREGNANCY AFTER ABDOMINAL VERSUS ROBOTICALLY ASSISTED LAPAROSCOPIC MYOMECTOMY. C. Celestine,a W. Ziegler,b V. Johnson,a Y.-H. Kuo,a J. Mann.b aJersey Shore University Medical Center, Neptune, NJ; bReproductive Science Center of NJ, Eatontown, NJ. OBJECTIVE: Leiomyomas are the most common benign tumor in females of reproductive age. Though most of these are asymptomatic, some myomas may impair fertility. Robotic myomectomy is a viable alternative to laparotomy. The aim of this study is to compare time to clinical pregnancy after abdominal myomectomy (Group 1) versus robotically assisted laparoscopic myomectomy (Group 2). DESIGN: Retrospective chart review with IRB approval. MATERIALS AND METHODS: Women who underwent a myomectomy for infertility from 2004 to 2013 were included. Baseline characteristics analyzed were age, gravidity, parity, maternal BMI, and history of cesarean delivery. Primary outcome was time to clinical pregnancy from time of surgical intervention. Clinical pregnancy was defined by the presence of fetal heart on ultrasound. Secondary outcomes were estimated blood loss (EBL), number of leiomyomata resected, uterine size, mode of conception, first trimester bleeding and subchorionic hematoma. Two-sample t-test or Wilcoxon rank sum test was used to compare continuous variables. Chisquared test was used to compare discrete variables. Statistical significance was set as p < 0.05. RESULTS: There were 154 myomectomies included in this study. Group 1 had 90 (58.4%) and group 2 had 64 (41.6%) cases. There was no difference in baseline characteristics. Outcomes are listed in Table 1. No malignancies were identified on pathology.

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