Abstract
Introduction: Past studies comparing perioperative outcomes of hysterectomy (HYST) and uterine artery embolization (UAE) do not control for demographically and insurer diverse populations. This study sought to identify the 30‑day readmission, 15‑day complication, and minimum 1‑year surveillance reintervention rates of diverse, propensity matched patients undergoing UAE or HYST for uterine leiomyoma.Methods: Adults from the New York’s Statewide Planning and Research Cooperative System (SPARCS) database 2009‑2013 who underwent HYST or UAE for uterine leiomyoma were retrospectively reviewed and 1:1 propensity matched. Univariate analysis compared demographics, complications, readmissions, and reintervention rates. Binary logistic and linear regression models identified independent predictors of outcomes.Results: A total of 682 patients were identified, where the number (n) of patients in each cohort was n=341, HYST, and n=341, UAE. Significance levels are shown with p values. No significant differences were identified between HYST and UAE demographics, complication (2.60% HYST vs 2.90% UAE, p=0.816) or readmission rates (3.20% HYST vs 3.80% UAE, p=0.678); 0.30% of UAE patients had a reintervention UAE and 2.90% of UAE patients had reintervention hysterectomy. HYST patients had a significantly longer average length of stay (2.59 days HYST vs 1.63 days UAE, p<0.001). The Deyo-Charlson (Deyo) comorbidity score positively predicted any complication with odds ratio=34.262, 95% confidence interval [4.938, 237.725], and p<0.001, but did not predict readmissions.Conclusion: HYST patients had significantly longer hospital stays. UAE and HYST had comparable readmission and complication rates. The Deyo comorbidity score was a significant predictor of any complication. This study supports the safety and efficacy of UAE when compared to HYST in demographic and insurer diverse populations.
Highlights
Past studies comparing perioperative outcomes of hysterectomy (HYST) and uterine artery embolization (UAE) do not control for demographically and insurer diverse populations
No significant differences were identified between HYST and UAE demographics, complication (2.60% HYST vs 2.90% UAE, p=0.816) or readmission rates (3.20% HYST vs 3.80% UAE, p=0.678); 0.30% of UAE patients had a reintervention UAE and 2.90% of UAE patients had reintervention hysterectomy
The Deyo-Charlson (Deyo) comorbidity score positively predicted any complication with odds ratio=34.262, 95% confidence interval [4.938, 237.725], and p
Summary
Past studies comparing perioperative outcomes of hysterectomy (HYST) and uterine artery embolization (UAE) do not control for demographically and insurer diverse populations. They can cause a variety of symptoms including, but not limited to, menorrhagia, dysmenorrhea, and impaired fertility. Uterine fibroids have an estimated cumulative incidence rate of 70% by age 50 in the United States [1]. Recent decades witnessed the introduction of alternative treatment methods such as uterine artery embolization (UAE), which was first described in 1995 [4]. The rate of HYST for uterine fibroids throughout the United States has decreased from 31.4% in 1997 to 26.9% in 2005 while the rate of UAE utilization increased in frequency [1,5]
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