National Utilization Trends of Inpatient Procedures for Symptomatic Uterine Fibroids and Adenomyosis: A 10-year Analysis.

Objective: To determine the changes in procedural utilization for symptomatic uterine fibroids and adenomyosis over the past decade.

Methods: An IRB-exempt retrospective study of the National Inpatient Sample database from 2011-2020 was performed utilizing ICD-9 and 10 diagnosis and procedural codes for uterine fibroids, adenomyosis, hysterectomy, myomectomy, UAE, and endometrial ablation. Patients with endometriosis, uterine cancer, placenta accreta spectrum, pelvic inflammatory disease, and uterine prolapse were excluded. Data was analyzed through statistical process control (SPC) and chi square testing.

Results: A total of 247,476 inpatient procedures were identified in women with fibroids and/or adenomyosis. Of those patients with only uterine fibroids (n=212,532), 77.9% underwent hysterectomy, 18.9% underwent myomectomy, and 2.8% underwent UAE. The utilization of UAE remained stable over the decade, while an increased prevalence of myomectomy was offset by a decrease in hysterectomy (2011: hysterectomy- 81.4%, myomectomy- 15.4%, UAE- 2.9%; versus 2020: 73.7%, 24.0%, and 2.0%, respectively). Regarding adenomyosis only (n= 16,073), more women underwent hysterectomy (98.1%) when compared to or UAE (1.1%), with minimal change in these procedures across the decade. For combined fibroids and adenomyosis (n=18,871), hysterectomy was the most utilized procedure, with its utilization declining from 92.0% to 85.2% during the time period.

Discussion: The utilization of hysterectomy remains the dominant inpatient procedural intervention for the treatment of uterine fibroids and adenomyosis, however the proportion of myomectomy in the setting of fibroids is increasing. Utilization of UAE has not changed over the past decade and remains relatively underutilized despite initiatives to increase utilization.