Matthew A. Patetta

National Utilization Trends of Inpatient Procedures for Symptomatic Uterine Fibroids and Adenomyosis: A 10-Year Analysis

The aim of this study was to determine changes in procedural utilization for symptomatic uterine fibroids and adenomyosis from 2011 to 2020. An institutional review board-exempt retrospective study of the National Inpatient Sample database from 2011 to 2020 was performed using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, diagnosis and procedural codes for uterine fibroids, adenomyosis, hysterectomy, myomectomy, uterine artery embolization (UAE), and endometrial ablation. Patients with endometriosis, uterine cancer, placenta accreta spectrum, pelvic inflammatory disease, and uterine prolapse were excluded. Data were analyzed using statistical process control and χ A total of 247,476 inpatient procedures were identified in women with fibroids and/or adenomyosis. Of those patients with only uterine fibroids (n = 212,532), 77.9% underwent hysterectomy, 18.9% underwent myomectomy, and 2.8% underwent UAE. The utilization of UAE remained stable over the decade, whereas an increased prevalence of myomectomy was offset by a decrease in hysterectomy (2011 versus 2020: hysterectomy, 81.4% versus 73.7%; myomectomy, 15.4% versus 24.0%; UAE, 2.9% versus 2.0%). Regarding adenomyosis only (n = 16,073), more women underwent hysterectomy (98.1%) compared with UAE (1.1%), with minimal change in these procedures across the decade. For combined fibroids and adenomyosis (n = 18,871), hysterectomy was the most utilized procedure, with its utilization declining from 92.0% to 85.2% during the time period. The utilization of hysterectomy remains the dominant inpatient procedural intervention for the treatment of uterine fibroids and adenomyosis, but the proportion of myomectomy in the setting of fibroids is increasing. Utilization of UAE did not change from 2011 to 2020, and it remains relatively underutilized despite initiatives to increase utilization.

A Decade Long Analysis of Healthcare Disparities and Uterine Artery Embolization: An Exploration of Social Determinants of Health

To determine the extent of impact that social determinants of health have on uterine artery embolization (UAE) utilization for treatment of symptomatic uterine fibroids. In this institutional review board (IRB)-exempt study, data from the 2011-2020 National Inpatient Sample were used to identify patients with International Classification of Diseases, 9th and 10th editions, codes of uterine fibroids who underwent UAE. Data collected included patient demographics (race/ethnicity, income, and insurance status) and procedure location (geographic region and hospital setting). Results are presented in percentage (UAE procedures per variable) and were analyzed using chi-square test. UAE utilization by race/ethnicity demonstrated the following distribution: 45.6% non-Hispanic Blacks, 28.1% non-Hispanic Whites, 14.2% Hispanics, and 5.7% Asians. The lowest quartile for income experienced no change in utilization (27.8%), while the highest quartile gradually decreased across the decade (2011, 26.7%; 2020, 19.0%; P = .01). The Northeast region of the United States (49.0% in 2011) was superseded by the South (34.8% in 2020) as the dominant geographic region for UAE. The main insurance statuses were private (55.5%) and Medicaid (26.2%), with Medicaid rates increasing throughout the decade (2011, 18.2%; 2020, 28.6%; P < .001). Urban teaching hospitals accounted for the highest rates of total UAE (82.3%) compared with urban nonteaching (16.0%) and rural hospitals (1.2%). Over the past decade, UAE has been performed in a relatively equitable fashion on the basis of income level, with improved utilization within the Medicaid population and throughout the geographic regions of the United States. When accounting for U.S. population representation and unequal disease burden, non-Hispanic Blacks demonstrated a greater-than-expected utilization of UAE compared with lower-than-expected rates among non-Hispanic Whites.