SIR 2024
Embolization
Tarig Elhakim, MD
Medicine Instructor & Research Associate
Penn (Medicine Instructor) & MGH (Research Associate)
Financial relationships: Full list of relationships is listed on the CME information page.
Sara Zhao, MD
Interventional Radiologist
Massachusetts General Hospital
Disclosure information not submitted.
Arian Mansur, BA (he/him/his)
Medical Student
Harvard Medical School
Disclosure information not submitted.
Maria Puello, None
Medical Student
Universidad Del Norte, Colombia
Disclosure information not submitted.
Anna Sophia McKenney, MD, PhD, MPH
Resident Physician
New York–Presbyterian Hospital/Weill Cornell Medical Center
Disclosure information not submitted.
Sanjeeva P. Kalva, MBBS, MD, RPVI, FSIR, FCIRSE, FACR (he/him/his)
Professor
Massachusetts General Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Michael Dezube, None
Senior Data Scientist
Massachusetts General Hospital
Disclosure information not submitted.
Dania Daye, MD, PhD
Assistant Professor of Radiology
Massachusetts General Hospital/Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
To perform a nationwide analysis of uterine fibroid embolization (UFE) compared to hysterectomy and myomectomy for uterine fibroid management, with attention to trends in utilization and disparities in access.
Materials and Methods:
Administrative data extracted from the National Inpatient Sample was obtained from the Healthcare Cost and Utilization Project and analyzed for the period between 2016 and 2020. After identifying the diagnosis of uterine fibroid based on ICD codes, we evaluated the utilization trends of UFE, hysterectomy, and myomectomy. The latter two were combined into one “surgical intervention” category for analysis. A multivariate logistic regression was performed to assess the influence of age, race, income, payer, and rural status to determine if any disparities exist.
Results:
Of the 474,855 inpatient encounters with uterine fibroids, 374,665 (78.9%) underwent hysterectomy, 93,410 (19.7%) myomectomy, and 6,780 (1.4%) underwent UFE. There was no significant difference in the mean age of those undergoing UFE (44.75, SD= 8.08) versus those undergoing surgical interventions (45.55, SD=9.45). Compared to White patients, African American and Asian patients were more likely to undergo UFE compared to surgical interventions (Odds ratio (OR): 1.5, 95% CI: 1.3-1.8, P < 0.001 and OR: 1.3, 95% CI: 1.03-1.7, P =0.02, respectively). Compared to patients on private insurance, those on Medicaid and self-pay were more likely to have UFE than surgical interventions (OR: 1.75, 95% CI: 1.5-2.0, P < 0.001, and OR: 1.86, 95% CI: 1.46-2.36, P < 0.001, respectively). Compared to patients living in dense metropolitan regions, those living in rural regions were significantly less likely to undergo UFE than surgical interventions (OR: 0.28, 95% CI: 0.18-0.45, P < 0.001). Additionally, when compared to procedures in 2016, patients were more likely to undergo UFE than surgical interventions in 2020 (OR: 1.6, 95% CI: 1.3-1.9, P < 0.001).
Conclusion:
In this national analysis, differences in UFE utilization were observed by race, insurance type, and population density. UFE utilization, compared to other surgical interventions, increased from 2016 to 2020. Further studies are needed to better evaluate reimbursement trends and understand access to UFE.