Hysterectomy and Myomectomy versus Uterine Artery Embolization for Symptomatic Fibroids and Adenomyosis: National and Regional Trends and Adverse Events in 70,000 Patients

PURPOSE: To compare patient characteristics, regional utilization, and postoperative outcomes among uterine artery embolization (UAE), myomectomy, and hysterectomy for fibroids and adenomyosis and assess whether postoperative adverse events were more common after hysterectomy. MATERIALS AND METHODS: This observational study identified all women who underwent UAE, myomectomy, or hysterectomy for fibroids or adenomyosis from 2016 to 2019 in the United States, using TriNetX, a multi-institution database of anonymous health records, yielding 78,758 patients, (UAE, 2,505; hysterectomy, 60,333; myomectomy, 15,920). Regional procedure utilization was assessed. Length of stay (LOS), reintervention, and postprocedural adverse events including pelvic floor prolapse and intestinal obstruction were compared. Pregnancy and miscarriage rates after UAE and myomectomy were evaluated. RESULTS: Compared with UAE, hysterectomy was associated with longer LOS (5 days vs 1 day; P < .01), more blood transfusions (1.8% vs 0.7%; P < .01), increased pelvic floor prolapse (7.1% vs 1.7%; P < .01) and intestinal obstruction (3.4% vs 1.2%; P < .01), and decreased reintervention (0% vs 15.5%; P < .01) within 5 years; myomectomy was associated with more blood transfusions (2.0% vs 0.7%; P < .01), fewer emergency department visits within 1 month (2.9% vs 6.8%; P = .01), and similar reintervention rates (17.0% vs 15.5%; P = .06). Pregnancy occurred in 92 of 2,505 patients who underwent UAE (3.6%) and 2,744 of 15,920 patients who underwent myomectomy (17.2%), with 18% and 11% miscarriage rates, respectively (P = .07). UAE utilization was similar across U.S. regions. CONCLUSIONS: Despite increased adverse events including intestinal obstruction and pelvic floor prolapse, hysterectomy was the most common intervention in women with uterine fibroids and adenomyosis. Reintervention occurred in 15%-20% of patients after UAE or myomectomy.