Variation in readmission and treatment reintervention rates after uterine artery embolisation and myomectomy in England: a cohort study
File(s)
Author(s)
Amoah, Alison
Type
Thesis
Abstract
Uterine fibroids are highly prevalent and can cause significant morbidity in women. Women are increasingly seeking uterine-preserving therapies as treatment for their symptoms as an alternative to hysterectomy. Myomectomy and uterine artery embolization (UAE) are commonly performed treatments for fibroids, but there are relatively few studies on their comparative effectiveness and a paucity of research investigating long-term outcomes following both treatments, such as reintervention.
This study sought to investigate reintervention as an outcome following myomectomy and UAE in England. This thesis aimed to investigate whether the available evidence base might reveal outcome disparities. As disparities can stem from unstandardised guideline recommendations, a systematic review assessed the quality and consensus of recommendations within national and international fibroid management guidelines. There were several areas of disagreement and imprecision, and almost one-third of the recommendations were based on expert opinion. A further systematic review investigated outcomes within fibroid randomised controlled trials (RCTs) towards the development of a core outcome set, which is a standardised set of outcomes that should be reported in all future trials. There was significant variation: 23 separate primary outcomes and 173 secondary outcomes reported across 60 RCTs.
Novel work used data from National Health Service (NHS) Hospital Episode Statistics datasets in a national, population-based observational study to investigate reintervention following myomectomy and UAE in England, using linkage methodology. In a study involving 10869 myomectomies and 6851 UAE cases, there was a 2.4-fold increased uterine-preserving procedure (UPP) rate (OR 2.47 95% CI 2.15 – 2.84) and a 2.3-fold increased hysterectomy reintervention rate (OR 2.26 95% CI 2.01 – 2.54) following UAE when compared to myomectomy, with a median follow-up duration of seven years. Further work aimed to investigate disparities in reintervention outcomes according to ethnicity, geographical region, surgical case volume, and social deprivation.
This study sought to investigate reintervention as an outcome following myomectomy and UAE in England. This thesis aimed to investigate whether the available evidence base might reveal outcome disparities. As disparities can stem from unstandardised guideline recommendations, a systematic review assessed the quality and consensus of recommendations within national and international fibroid management guidelines. There were several areas of disagreement and imprecision, and almost one-third of the recommendations were based on expert opinion. A further systematic review investigated outcomes within fibroid randomised controlled trials (RCTs) towards the development of a core outcome set, which is a standardised set of outcomes that should be reported in all future trials. There was significant variation: 23 separate primary outcomes and 173 secondary outcomes reported across 60 RCTs.
Novel work used data from National Health Service (NHS) Hospital Episode Statistics datasets in a national, population-based observational study to investigate reintervention following myomectomy and UAE in England, using linkage methodology. In a study involving 10869 myomectomies and 6851 UAE cases, there was a 2.4-fold increased uterine-preserving procedure (UPP) rate (OR 2.47 95% CI 2.15 – 2.84) and a 2.3-fold increased hysterectomy reintervention rate (OR 2.26 95% CI 2.01 – 2.54) following UAE when compared to myomectomy, with a median follow-up duration of seven years. Further work aimed to investigate disparities in reintervention outcomes according to ethnicity, geographical region, surgical case volume, and social deprivation.
Version
Open Access
Date Issued
2023-11-30
Date Awarded
2026-03-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Khullar, Vik
Regan, Lesley
Quinn, Stephen
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
Department of Metabolism, Digestion and Reproduction
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)