Objective
To compare risk of re-intervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent following procedures: hysterectomy, myomectomy, uterine artery embolization (UAE), and magnetic resonance–guided, focused ultrasound surgery.
Methods
This was a retrospective analysis of administrative claims from a large U.S. commercial insurance database. Women aged 18–54 years undergoing any of the above leiomyoma procedures between 2000 and 2013 were included. We assessed following outcome measures: risk of re-intervention between uterine-sparing procedures, risk of other surgical procedures or complications of the index procedure, 5-year health care utilization; pregnancy rates, and reproductive outcomes. Propensity score matching along with Cox proportional hazard models were used to adjust for differences in baseline characteristics between study cohorts.
Results
Among the 135,522 study-eligible women with mean follow-up of 3.4 years, hysterectomy was the most common first-line procedural therapy (111,324; 82.2%) followed by myomectomy (19,965; 14.7%), UAE (4,186; 3.1%) and magnetic resonance–guided focused ultrasound surgery (47; 0.0003%). Small but statistically significant differences were noted for UAE and myomectomy in re-intervention rate (17.1% versus 15.0%, p=0.02), subsequent hysterectomy rates (13.2% versus 11.1%, p<0.01) and subsequent complications from index procedures (18.1% versus 24.6%, p<0.001). During follow-up, women undergoing myomectomy had lower leiomyoma-related health care utilization, but had higher all-cause outpatient services. Pregnancy rates were 7.5% and 2.2% among myomectomy and UAE cohorts, respectively (p<0.001), with both cohorts having similar rate of adverse reproductive outcome (69.4%).
Conclusions
While the overwhelming majority of women having leiomyoma with bulk symptoms underwent hysterectomy as their first treatment procedure, among those undergoing uterine-sparing index procedures, approximately one seventh had a re-intervention, and one tenth ended up undergoing hysterectomy during follow-up. Compared with women undergoing myomectomy, women undergoing UAE had a higher risk of re-intervention, lower risk of subsequent complications, but similar rate of adverse reproductive outcomes.