Surgical Management of Uterine Fibroids: A Large Retrospective Study

STUDY OBJECTIVE: To analyze trends in surgical management of uterine fibroids and identify factors influencing surgical decisions among Chinese women over the past decade. DESIGN: Retrospective cohort study. SETTING: Four campuses of Tongji Hospital, a tertiary care center in Wuhan, China. PATIENTS: Of the 104,430 women screened, 13,344 were diagnosed with uterine fibroids and underwent surgical treatment between 2013 and 2022. Exclusion criteria were concurrent adenomyosis, uterine fibroids found unexpectedly during unrelated surgery (e.g., genital cancer), and pregnant women with uterine fibroids. INTERVENTIONS: Hysterectomy, myomectomy. MEASUREMENTS AND MAIN RESULTS: Data from surgical inpatients were analyzed for annual rates of hysterectomies and myomectomies. Univariate and multivariate logistic regression models were used to identify factors associated with choice of surgery. From 2013 to 2022, hysterectomy rates decreased from 42.3% to 33.1%, with the most pronounced decline observed in the 45 to 49 age group (a 21.1 percentage point decrease), followed by the 40 to 44 age group (a 15.6 percentage point decrease). Myomectomy rates increased from 57.7% to 66.9%. Factors associated with an increased likelihood of hysterectomy included clinically significant symptoms, lower preoperative hemoglobin, multiple uterine fibroids, older age at admission, later age at menarche, and higher body mass index. Notably, among patients who underwent hysterectomies, 34.9% also had oophorectomies, compared to 1.1% in the myomectomy group. CONCLUSIONS: Surgical management of uterine fibroids in central China has shifted toward increased use of myomectomy over hysterectomy, particularly among women aged 40 to 49. This transition is critical given potential adverse outcomes associated with hysterectomy in premenopausal women.