Racial disparities and risk factors for blood transfusion in patients undergoing myomectomy for uterine fibroids: insights from a national surgical database

Facts Views Vis Obgyn. 2026 Jun 22;18(2):85-93. doi: 10.52054/FVVO.2026.202.

ABSTRACT

BACKGROUND: Uterine fibroids are common among reproductive-aged women, with notable racial disparities in disease burden and outcomes. Myomectomy is a fertility-sparing surgical treatment associated with variable transfusion risk.

OBJECTIVES: To evaluate racial disparities and identify risk factors for blood transfusion in patients undergoing myomectomy, and to develop a predictive model for high-risk patients.

METHODS: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Project (2018-2022) to identify women aged 18-55 years who underwent myomectomy. Patients with malignancy or bleeding disorders were excluded. Multivariable logistic regression was used to assess transfusion predictors and racial disparities.

MAIN OUTCOME MEASURES: Incidence and predictors of perioperative blood transfusion; model performance for transfusion prediction.

RESULTS: Among 6,154 patients, 604 (9.8%) required transfusion. Non-Hispanic Black patients accounted for 74.3% of transfusion cases (vs. 52.0%, P<0.001) and had over twice the adjusted odds of transfusion compared to Non-Hispanic White patients [adjusted odds ratio (aOR): 2.1, 95% confidence interval: 1.6-2.7]. Preoperative anaemia (aOR: 8.5), abdominal approach (aOR: 4.7), and fibroid burden (>250 grams) (aOR: 2.0) were also significant. The predictive model demonstrated excellent discrimination (area under the receiver operating characteristic curve: 0.79).

CONCLUSIONS: Non-Hispanic Black patients face higher transfusion risks during myomectomy, even after adjusting for clinical factors. Interventions targeting anaemia and prioritising minimally invasive approaches may reduce these disparities.

WHAT IS NEW?: This study explores recent racial disparities in blood transfusion among myomectomy patients and assesses how these patterns have evolved in recent years using a nationally representative surgical dataset.

PMID:42328926 | PMC:PMC13285366 | DOI:10.52054/FVVO.2026.202