Patient Characteristics Associated With Embolization Versus Hysterectomy for Uterine Fibroids: A Systematic Review and Meta-Analysis

Tara Srinivas; Bethlehem Lulseged; Mohammad Mirza Aghazadeh Attari; Mostafa Borahay; Clifford R Weiss

doi:10.1016/j.jacr.2023.12.018

Patient Characteristics Associated With Embolization Versus Hysterectomy for Uterine Fibroids: A Systematic Review and Meta-Analysis

J Am Coll Radiol. 2024 May;21(5):729-739. doi: 10.1016/j.jacr.2023.12.018. Epub 2024 Jan 6.

Authors

Tara Srinivas¹, Bethlehem Lulseged¹, Mohammad Mirza Aghazadeh Attari², Mostafa Borahay³, Clifford R Weiss⁴

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Associate Professor of Gynecology and Obstetrics, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Director of the Division of General Gynecology & Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
⁴ Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Director of the Johns Hopkins HHT Center of Excellence and Professor of Radiology and Radiological Science, Baltimore, Maryland. Electronic address: cweiss@jhmi.edu.

PMID: 38191081
DOI: 10.1016/j.jacr.2023.12.018

Abstract

Introduction: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UFs) and experience more severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than the common alternative, open hysterectomy. To determine whether demographic disparities persist in UF treatment utilization, we reviewed patient characteristics associated with UAE versus hysterectomy for UF among studies of US clinical practices.

Methods: A systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger's regression test was used to quantify publication bias.

Results: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P < .01) and young age (P < .05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P = .52). Between-study heterogeneity (I² > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance.

Conclusions and implications: Knowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts.

Keywords: Health equity; hysterectomy; leiomyoma; uterine artery embolization; uterine fibroid.

Publication types

Systematic Review
Meta-Analysis
Comparative Study

MeSH terms

Female
Humans
Hysterectomy*
Leiomyoma* / surgery
Leiomyoma* / therapy
United States
Uterine Artery Embolization*
Uterine Neoplasms* / surgery
Uterine Neoplasms* / therapy