Hysterectomy and Myomectomy vs Uterine Artery Embolization for Symptomatic Fibroids and Adenomyosis: National and Regional Trends and Adverse Events in 70,000 Patients.

Abstract

Purpose: To compare patient characteristics, regional utilization, and post-operative outcomes between uterine artery embolization (UAE), myomectomy and hysterectomy for fibroids and adenomyosis, and assess whether post-operative adverse events were more common after hysterectomy.

Materials and methods: This observational study identified all women who underwent UAE, myomectomy or hysterectomy for fibroids or adenomyosis from 2016-2019 in the US, using TriNetX, a multi-institution database of anonymous health records, yielding 78,758 patients, (UAE: 2,505; hysterectomy: 60,333; myomectomy: 15,920). Regional procedure utilization was assessed. Length of stay (LOS), re-intervention, and post-procedure adverse events including pelvic floor prolapse and intestinal obstruction were compared. Pregnancy and miscarriage rates after UAE and myomectomy were assessed.

Results: Compared to UAE, hysterectomy was associated with longer LOS (5 v. 1 day, P<0.01), more blood transfusions (1.8 v. 0.7%, P<0.01), increased pelvic floor prolapse (7.1 v. 1.7%, P<0.01) and intestinal obstruction (3.4 v. 1.2%, P<0.01), and decreased reintervention (0 v. 15.5%, P<0.01) within 5 years; myomectomy was associated with more blood transfusions (2.0 v. 0.7%, P<0.01), fewer emergency room visits within 1 month (2.9 v. 6.8%, P=0.01), and similar re-intervention rates (17.0 v. 15.5%; P=0.06). Pregnancy occurred in 92/2,505 (3.6%) UAE and 2,744/15,920 (17.2%) myomectomy patients, with 18% and 11% miscarriage rates, respectively (P=0.07). UAE utilization was similar across US regions.

Conclusion: Despite increased adverse events including intestinal obstruction and pelvic floor prolapse, hysterectomy was the most common intervention in women with uterine fibroids and adenomyosis. Reintervention occurred after in 15-20% of patients after UAE or myomectomy.