Uterine‐preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long‐term outcomes

Abstract

Objective To assess comparative rates of further uterine‐preserving procedures (UPP) or hysterectomy reintervention, after myomectomy or uterine artery embolisation (UAE). Design Population‐based, retrospective cohort study. Setting England. Population Women who underwent myomectomy or UAE between 2010 and 2015 under the NHS. Methods Data was abstracted from NHS Health Episode Statistics datasets. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional‐hazards regression. Main Outcomes Measures 30‐day readmission, UPP and hysterectomy reintervention rates. Results 9443 and 6224 women underwent elective myomectomy or UAE, respectively. After 118 136 total person‐years of follow‐up, the rate of hysterectomy was 8.34 and 20.98 per 1000 patient years for myomectomy or UAE, respectively. There was a 2.4‐fold increased risk of undergoing hysterectomy after UAE when compared with myomectomy in adjusted models (HR 2.38 [95% CI 2.10–2.66]) [adjusted for age, ethnicity, multiple deprivation index, geographical region and comorbidities]. The HR for undergoing a UPP reintervention was 1.44 (95% CI 1.29–1.60) in favour of myomectomy. The rate of hysterectomy was increased 22% following UAE compared with laparoscopic myomectomy (0.97–1.52). Age may influence reintervention rates, and there was variation in hysterectomy risk when stratified by geographical region. Conclusions After a median of 7 years of follow‐up, there is a 2.4‐fold increased rate of hysterectomy and 44% increased risk of UPPs as reintervention after UAE, relative to myomectomy. These findings will aid pre‐procedure counselling for women with fibroids. Future work should investigate the effect of other outcome modifiers, such as fertility intentions and fibroid anatomical characteristics.

Long-Term Risk of Reintervention After Surgical Leiomyoma Treatment in an Integrated Health Care System

“…Our finding that patients with myomectomy have a lower risk of reintervention than patients with uterine artery embolization, endometrial ablation, and hysteroscopic myomectomy is broadly consistent with previous findings and extends prior research by directly comparing reintervention risk over more than 7 years of follow-up time. [3][4][5] Another recent study with 7 years of follow-up reported that risk of uterus-preserving reintervention was 1.4 times greater and risk of hysterectomy was 2.4 times greater after uterine artery embolization compared with myomectomy, 11 similar to our findings over all follow-up time. Reintervention rates may be lower after myomectomy because some otherwise asymptomatic patients pursue myomectomy to treat infertility.…”

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

“…A sensitivity analysis, omitting the poorer designed study, 21 found that UAE stays remain signi cantly shorter than MYO's (MD, -47.98; 95% CI, -48.80 to -47.17; P < 0.01; heterogeneity: I 2 = 0%). For readmissions, Amoah 24 reported a bigger discrepancy in MYO vs. UAE. However, two studies 17,19 presented similar morbidities.…”

Author's reply

“…Dear Dr Papageorghiou, We thank Strong and Odejinmi 1 for their comments on our national study utilising routinely collected NHS Hospital Episode Statistics (HES) data to compare long-term reintervention rates following myomectomy and UAE in England. 2 Undoubtedly, uterine fibroid research represents an underfunded, understudied area. There has been over-representation of single-centre single-arm research focusing on short-term outcomes after fibroid treatments.…”