November 25, 2005

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

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.