Borah B, et al. - This study was planned to perform a comparison of risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery. Although hysterectomy was performed as the first treatment procedure on the overwhelming majority of women having leiomyoma with bulk symptoms, among those undergoing uterine-sparing index procedures, approximately one-seventh had a reintervention, and one tenth ended up undergoing hysterectomy during follow-up. Women undergoing uterine artery embolization indicated a greater risk of reintervention, lower risk of subsequent complications, but a comparable rate of adverse reproductive outcomes when compared with women undergoing myomectomy.

Methods

• Researchers performed a retrospective analysis of administrative claims from a large U.S. commercial insurance database.
• They included women aged 18–54 years undergoing any of the previously mentioned leiomyoma procedures between 2000 and 2013.
• The following outcome measures were determined: risk of reintervention 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.
• They used propensity score matching along with Cox proportional hazard models to adjust for differences in baseline characteristics between study cohorts.

Results

• Researchers recognized 135,522 study-eligible women; mean follow-up period was 3.4 years; hysterectomy was identified as the most common first-line procedural therapy (111,324 [82.2%]) followed by myomectomy (19,965 [14.7%]), uterine artery embolization (4,186 [3.1%]) and magnetic resonance-guided focused ultrasound surgery (47 [0.0003%]).
• They noticed small but statistically relevant differences for uterine artery embolization and myomectomy in reintervention rate (17.1% compared with 15.0%, P=.02), subsequent hysterectomy rates (13.2% compared with 11.1%, P<.01) and subsequent complications from index procedures (18.1% compared with 24.6%, P<.001).
• Women undergoing myomectomy utilized lower leiomyoma-related health care, but had higher all-cause outpatient services during follow-up.
• Myomectomy and uterine artery embolization cohorts had similar rates of adverse reproductive outcome (69.4%), but had pregnancy rates of 7.5% and 2.2%, respectively (P<.001).