National Utilization Trends of Inpatient Procedures for Symptomatic Uterine Fibroids and Adenomyosis: A 10-Year Analysis

Patetta MA, Matthew A Patetta, Griffith KN, Kira N Griffith, Joshua A Walker, Walker JA, Maureen P. Kohi, Kohi MP, Sarah J Nyante, Nyante SJ, Gloria Salazar, Salazar G, Nicole Keefe, Nicole A Keefe
Journal of the American College of Radiology : JACR · 2025 · vol. 22(4) , pp. 417–424 · doi:10.1016/j.jacr.2024.11.031 · PMID:39662714
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This 10-year analysis of inpatient procedures found that while hysterectomy remains the dominant treatment for uterine fibroids and adenomyosis, myomectomy utilization increased for fibroids, whereas uterine artery embolization remained stable and underutilized.

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This paper used a 10-year analysis of national inpatient data to examine utilization trends of inpatient procedures performed for symptomatic uterine fibroids and adenomyosis, assessing how procedure patterns changed over time. The authors focused on inpatient procedure utilization at the national level, describing overall trends and relevant shifts in the types of procedures used for these diagnoses. A major caveat is that administrative inpatient databases capture procedure utilization without clinical detail, limiting the ability to determine appropriateness, symptom severity, or indications driving specific treatment choices. This paper is centrally about endometriosis and/or adenomyosis—specifically adenomyosis—because it quantifies national utilization trends for inpatient procedures for symptomatic uterine fibroids and adenomyosis.

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Abstract

PURPOSE: The aim of this study was to determine changes in procedural utilization for symptomatic uterine fibroids and adenomyosis from 2011 to 2020. METHODS: An institutional review board-exempt retrospective study of the National Inpatient Sample database from 2011 to 2020 was performed using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, diagnosis and procedural codes for uterine fibroids, adenomyosis, hysterectomy, myomectomy, uterine artery embolization (UAE), and endometrial ablation. Patients with endometriosis, uterine cancer, placenta accreta spectrum, pelvic inflammatory disease, and uterine prolapse were excluded. Data were analyzed using statistical process control and χ2 testing. RESULTS: A total of 247,476 inpatient procedures were identified in women with fibroids and/or adenomyosis. Of those patients with only uterine fibroids (n = 212,532), 77.9% underwent hysterectomy, 18.9% underwent myomectomy, and 2.8% underwent UAE. The utilization of UAE remained stable over the decade, whereas an increased prevalence of myomectomy was offset by a decrease in hysterectomy (2011 versus 2020: hysterectomy, 81.4% versus 73.7%; myomectomy, 15.4% versus 24.0%; UAE, 2.9% versus 2.0%). Regarding adenomyosis only (n = 16,073), more women underwent hysterectomy (98.1%) compared with UAE (1.1%), with minimal change in these procedures across the decade. For combined fibroids and adenomyosis (n = 18,871), hysterectomy was the most utilized procedure, with its utilization declining from 92.0% to 85.2% during the time period. CONCLUSIONS: The utilization of hysterectomy remains the dominant inpatient procedural intervention for the treatment of uterine fibroids and adenomyosis, but the proportion of myomectomy in the setting of fibroids is increasing. Utilization of UAE did not change from 2011 to 2020, and it remains relatively underutilized despite initiatives to increase utilization.
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National Utilization Trends of Inpatient Procedures for Symptomatic Uterine Fibroids and Adenomyosis: A 10-Year Analysis Affiliations & Notes aDivision of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina bErnest H. Wood Distinguished Professor & Chair, Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina cDivision of Cancer Epidemiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina dAssociate Professor, Vice Chair of Health Equity & Community Engagement, Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina eAssistant Professor, Interventional Radiology Residency Program Director, Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina Article Info Publication History: Published online December 9, 2024 Footnotes: The authors state that they have no conflict of interest related to the material discussed in this article. All authors are non-partner/non-partnership track/employees. DOI: 10.1016/j.jacr.2024.11.031 External LinkAlso available on ScienceDirect External Link Copyright: © 2024 American College of Radiology Linked Articles Download started OkVisual Abstract Key Words References 1. Viswanathan, M. ∙ Hartmann, K. ∙ McKoy, N. ... Management of uterine fibroids: an update of the evidence Evid Rep Technol Assess (Full Rep). 2007; 1-122 2. Herve, F. ∙ Katty, A. ∙ Isabelle, Q. ... Impact of uterine fibroids on quality of life: a national cross-sectional survey Eur J Obstet Gynecol Reprod Biol. 2018; 229:32-37 3. Kohi, M.P. ∙ Spies, J.B. Updates on uterine artery embolization Semin Intervent Radiol. 2018; 35:48-55 4. 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endometriosisadenomyosis

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Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

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