Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas

Abstract

Objective: To compare short-term health-related quality of life (HRQOL) 6-12 weeks after hysterectomy or myomectomy for the treatment of symptomatic leiomyomas.

Methods: We conducted a prospective comparative effectiveness analysis of data. In an existing multisite registry, we compared 6-12-week postsurgical HRQOL using the disease-specific Uterine Fibroid Symptom Quality of Life and the generic EuroQoL 5-Dimension Health Questionnaire, in women from the ages of 18-54 years with documented leiomyomas undergoing hysterectomy or myomectomy. Propensity score weighting was used to adjust for confounding, and analyses were also stratified by route of surgery.

Results: A total of 1,295 patients (727 with hysterectomy and 568 with myomectomy) enrolled from registry initiation in November 2015 until June 2018 met inclusion criteria. At baseline, leiomyoma-specific HRQOL (44.0±25.4 and 50.2±25.3, P<.01), symptom severity (60.7±23.6 and 51.7±24.6, P<.01), and generic HRQOL (69.3±20.4 and. 73.4±18.9, P<.01) were significantly different between the hysterectomy compared with myomectomy groups, respectively. Differences were eliminated by propensity adjustment. Substantial improvement in HRQOL measures were seen in both groups at 6-12 weeks, with the mean propensity-adjusted symptom severity score 4 points lower in hysterectomy patients (mean difference -4.6; 95% CI -7.0 to -2.3), compared with myomectomy patients. Hysterectomy patients had better scores on the concern and self-consciousness subscales compared with myomectomy patients. When stratified by surgical route, these two subscale findings were similar between minimally invasive hysterectomy and minimally invasive myomectomy. Symptom severity scores did not differ after abdominal myomectomy compared with abdominal hysterectomy, but subscale scores on activity and energy/mood were higher with myomectomy.

Conclusion: Both hysterectomy and myomectomy were associated with substantial improvement in HRQOL at short-term follow-up, with small but statistically significant differences in symptom severity and certain subscales.

Clinical trial registration: ClinicalTrials.gov, NCT02260752.

Conflict of interest statement

Financial Disclosure

Elizabeth Stewart received money from Bayer and UpToDate. She received funds from Gynesonics, Welltwigs, Abbvie, Allergan, Med Learning Group. A patent was awarded but no commercial activity for “Methods and Compounds for Treatment of Abnormal Uterine Bleeding 6440445.” Shannon Laughlin-Tommaso received money paid to her from Allergan Pharmaceuticals and UpToDate (fibroid articles). Vanessa Jacoby received money paid to her institution from Acessa Health. Sateria Venable has a financial relationship with Myovant AbbVie. Money has also been paid to his institution from NIH/NICHD, State of Georgia, Yale University, Bayer, ObsEva, AbbVie, Augusta University, and Wayne State University. He is on the Board of Directors and a stock holder for Advanced Reproductive Care and a consultant to Actamax, ZSX Medical, Temple Therapeutics, Seikagaku Corporation, AEGEA, and Trevi Therapeutics. Evan R. Myers has received money paid to him from Allergan, AbbVie, Bayer, and Merck. The other authors did not report any potential conflicts of interest.

Figures

Fig. 1.

Exclusion criteria for analytic population. COMPARE-UF, Comparing Options for Management: Patient-centered Results for Uterine Fibroids.