Association Between Patient Characteristics and Treatment Procedure Among Patients With Uterine Leiomyomas

Bijan J Borah, Shannon K Laughlin-Tommaso, Evan R Myers, Xiaoxi Yao, Elizabeth A Stewart
Obstetrics and gynecology · 2015 · vol. 127(1) , pp. 67–77 · doi:10.1097/aog.0000000000001160 · PMID:26646122 · W2207559567
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Abstract

OBJECTIVE: To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure. METHODS: We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure. RESULTS: The study sample comprised 96,852 patients (endometrial ablation=12,169; myomectomy=7,039; uterine artery embolization=3,835; and hysterectomy=73,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility. CONCLUSION: Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.

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mesh:D004715mesh:D017699endometriosisinfertility

MeSH descriptors

Catheter Ablation Hysterectomy Leiomyoma Organ Sparing Treatments Uterine Artery Embolization Uterine Myomectomy Uterine Neoplasms Adult Age Factors Black or African American Black or African American Catheter Ablation Educational Status Endometriosis Endometriosis Female Health Maintenance Organizations Health Maintenance Organizations Humans Hysterectomy

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