Comparison of uterine artery embolization and myomectomy: A long-term analysis of 863 patients
| Autor: | Janis F. Yao, Eric Mastrolonardo, Emilie T. Nguyen, Anoop Ravilla, Ilya Lekht, Jean Min, Jemianne Bautista Jia |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Blood transfusion business.industry Uterine fibroids Obstetrics Medical record medicine.medical_treatment Hazard ratio Significant difference Retrospective cohort study General Medicine medicine.disease 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Uterine artery embolization 030220 oncology & carcinogenesis Clinical endpoint Medicine business |
| Zdroj: | American Journal of Interventional Radiology. 5:1 |
| ISSN: | 2572-4606 2572-4614 |
| DOI: | 10.25259/ajir_30_2020 |
| Popis: | Objectives: The objective of this study is to compare the rates of secondary intervention following uterine artery embolization (UAE) versus myomectomy for the treatment of symptomatic uterine fibroids. Material and Methods: This is a multicenter retrospective cohort study. Eight hundred and sixty-three patients are included in this analysis, 451 patients who underwent UAE and 412 patients who underwent myomectomy between January 1, 2008, and December 31, 2012. The UAE group was significantly older than the myomectomy group with a median age of 46 versus 38 (P < 0.0001). Patient data were collected from electronic medical records between the time of their initial procedure and December 31, 2017. The primary endpoint was secondary intervention rate. Secondary endpoints included time to secondary intervention, post-procedural complications, differences in mean hemoglobin levels following the procedures, symptomatic improvement, and subsequent pregnancy outcomes. All statistical analyses were two sided and performed using SAS EG 7.13 (Cary, NC). Results: The median follow-up for the UAE and myomectomy groups was 7 and 7.3 years, respectively. Overall, the rates of secondary intervention were not statistically significant between the UAE and myomectomy groups, 8.9% and 11.2%, respectively (P = 0.26). However, stratified analysis in women aged 30–39 years old demonstrated an increased rate of secondary intervention in the UAE arm with a hazards ratio of 3.76 (P = 0.0099). In patients ≥40 years old, there was no significant difference in secondary intervention rate. Both groups demonstrated a significant increase in mean hemoglobin at 1 year following initial procedure with a mean difference (SD) of 1.8 (2.1) in the UAE group and 1.8 (2.5) in the myomectomy group (P < 0.0001 for both groups). The myomectomy group had a higher rate of post-procedural blood transfusion than the UAE group, 2.9% versus 0.9%, respectively (P = 0.028). Both groups had comparable rates of post-procedural pelvic infection and rehospitalization. Patients with pre-procedural menorrhagia who received UAE reported a higher rate of symptomatic improvement when compared to the myomectomy group, 75.4% versus 49.5% (P < 0.0001). Both groups reported similar rates of improvement in bulk symptoms, 46.1% and 43.2%, respectively (P = 1.0). Conclusion: Overall, UAE and myomectomy have comparable rates of secondary intervention during a median 7-year follow-up period. However, in women between 30 and 39 years of age, UAE resulted in higher rates of secondary intervention. UAE may be more effective in controlling patients’ menorrhagia and has lower rates of post-procedural blood transfusions. |
| Databáze: | OpenAIRE |
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