AHRQ Statistical Brief: Hysterectomies To Treat Uterine Fibroids Fell 20 Percent From 2005 to 2013

The rate of women choosing hysterectomy (surgery to remove the uterus) to treat benign uterine fibroids decreased 20 percent between 2005 and 2013, according to a new AHRQ statistical brief. While benign fibroids pose no problem for many women, others experience heavy bleeding, pain, frequent urination and increased risk of pregnancy complications. In 2005, about 211 out of 100,000 women ages 18 to 54 had a hysterectomy to treat benign fibroids; by 2013, the rate fell to 168 per 100,000 women. Hysterectomy still remains the most common treatment for uterine fibroids, but the new data show that hysterectomies performed in hospital-based ambulatory surgery settings increased more than fivefold while hysterectomies performed in hospitals decreased by half. Meanwhile the rate of uterine fibroid embolization, a treatment that blocks the blood supply to the fibroids, increased about 175 percent in both ambulatory surgery and inpatient settings. Details of these and other findings are shown in AHRQ’s Healthcare Cost and Utilization Project Statistical Brief, “Procedures to Treat Benign Uterine Fibroids in Hospital Inpatient and Hospital-Based Ambulatory Surgery Settings, 2013.”

Highlights

In 2013, four surgical procedures for benign uterine fibroids were about as common in the hospital-based ambulatory surgery (AS) setting as in the inpatient setting (47.8 vs. 52.2 percent). Compared with inpatient stays, AS visits had a shorter average length of stay (0.6 vs. 2.3 days) and lower average hospital charges ($25,200 vs. $28,000).

Between 2005 and 2013, the overall rate of hysterectomy decreased by 20 percent, from 210.8 to 168.0 per 100,000 women aged 18-54 years. This change was driven by a 52 percent decrease in the rate of inpatient hysterectomy. The rate of AS hysterectomy increased by over 400 percent during this time period.

The rate of inpatient myomectomy decreased by 29 percent, and the rate of AS myomectomy remained relatively constant. The rate of both inpatient and AS uterine fibroid embolization increased by approximately 170 percent. The rate of endometrial ablation decreased in both the inpatient and AS settings (40 and 19 percent decrease, respectively).

To treat benign uterine fibroids, Black and Hispanic women more commonly had inpatient surgery whereas White women more commonly had AS.

Private insurance was the predominant expected payer for both inpatient stays and AS visits involving procedures to treat benign uterine fibroids. Medicaid paid for more inpatient stays than AS visits.

Procedures to Treat Benign Uterine Fibroids in Hospital Inpatient and Hospital-Based Ambulatory Surgery Settings, 2013

Marguerite L. Barrett, M.S., Audrey J. Weiss, Ph.D., Carol Stocks, Ph.D., R.N., Claudia A. Steiner, M.D., M.P.H., and Evan R. Myers, M.D., M.P.H.

Introduction

By the age of 50, as many as 70-80 percent of women will develop uterine fibroids (leiomyomas)—typically benign tumors of the uterus.^1,2 For many women, uterine fibroids pose no health risks and women are asymptomatic. For others, uterine fibroids may cause symptoms such as heavy bleeding, pain, and frequent urination, and they are associated with an increased risk of pregnancy complications.³ Some women are more likely than others to develop uterine fibroids. For instance, uterine fibroids are more common in Black than in White women,⁴ and Black women tend to have more severe symptoms.⁵ Research also indicates that, compared with White women, Black women develop uterine fibroids at a younger age and have more severe fibroids (e.g., larger size, number, and growth rate).^6,7,8

For women with symptomatic fibroids, a variety of treatment options are available.⁹ Women with mild symptoms may choose medical treatments such as pain relievers and hormonal drugs. Those with moderate to severe symptoms may need surgery to treat uterine fibroids. Common surgical treatment options include hysterectomy (removing the uterus), myomectomy (removing the fibroids), uterine fibroid embolization (blocking the blood supply to the fibroids), and endometrial ablation (removing the lining of the uterus, which controls bleeding without directly affecting the fibroids).

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on four surgical procedures to treat benign uterine fibroids among women aged 18-54 years in two hospital settings: hospital inpatient and hospital-based ambulatory surgery. Our analysis is limited to hospitals within 13 States—representing more than one-fourth of the U.S. population—that included data on surgical treatment of benign uterine fibroids in the inpatient and ambulatory surgery settings. We focus on four common surgical treatments of benign uterine fibroids: hysterectomy, myomectomy, uterine fibroid embolization, and endometrial ablation. An overview of characteristics of women with benign uterine fibroids who underwent one of these surgical treatments in 2013 is provided by hospital setting. We present trends in the four surgical procedures to treat benign uterine fibroids by hospital setting from 2005 through 2013. The distribution of these four procedures by patient race/ethnicity and expected primary payer in each hospital setting is provided for 2013. Only differences of at least 10 percent are noted in the text.

Findings

Characteristics of hospitalizations for benign uterine fibroids, 2013
Table 1 presents characteristics of hospitalizations for benign uterine fibroids treated with four common procedures in the hospital inpatient compared with the hospital-based ambulatory surgery setting in 2013.