Readmission a Risk with Fibroid Treatment

NEW YORK (Reuters Health) - For the treatment of fibroids, a minimally invasive procedure called uterine artery embolization (UAE) that cuts off blood to the benign tumors reduces hospital stay by nearly 3 days, compared with hysterectomy, but significantly increases the risk of readmission, Dutch researchers report.

Uterine fibroids can cause excessive menstrual bleeding, pelvic pain and frequent urination. The benign tumors occur in about 25 percent of all women and are the leading cause of hysterectomy, or removal of the uterus, in the US.

Previous reports have suggested that UAE, which involves inserting catheters into the arteries that supply blood to the uterus and injecting materials to permanently block these blood vessels, offers advantages over hysterectomy as a fibroid treatment, but studies investigating this issue have included women with a strong treatment preference and have lacked a control group.

Based on their results, Dr. W. J. K. Hehenkamp, from the Academic Medical Center in Amsterdam, and colleagues contend, "the question as to whether UAE is a good alternative to hysterectomy ... still remains to be answered."

Hehenkamp's team assessed the outcomes of 177 women with symptomatic uterine fibroids and excessive menstrual bleeding who were randomized to UAE or hysterectomy.

UAE was successful in 88.9 percent of women while hysterectomy was successful in 100 percent of women, they report in the American Journal of Obstetrics and Gynecology.

Major complications, defined as those that were life-threatening, caused permanent sequelae, or required surgical intervention, occurred in 4.9 percent of UAE-treated patients and in 2.7 percent of those who underwent hysterectomy.

The minor complication rate, by contrast, was significantly higher in the UAE group: 58.0 percent vs. 40.0 percent.

On average, UAE-treated patients were hospitalized for 2.5 days, roughly half as long as their peers who underwent hysterectomy. However, no patients in the hysterectomy group required readmission, whereas 11.1 percent of UAE-treated patients did.

"UAE," the authors conclude, "is a procedure similar to hysterectomy with a low major complication rate and with a reduced length of hospital stay. Higher readmission rates after UAE stress the need for careful postprocedural follow-up."

SOURCE: American Journal of Obstetrics and Gynecology, November 2005.