Kedra Wallace1, Shuaiqi Zhang2, Laine Thomas2, Elizabeth A Stewart3, Wanda Kay Nicholson4, Ganesa R Wegienka5, Lauren A Wise6, Shannon K Laughlin-Tommaso3, Michael P Diamond7, Erica E Marsh8, Vanessa L Jacoby9, Raymond M Anchan10, Sateria Venable11, G Maxwell Larry12, Barbara Lytle13, Tracy Wang13, Evan R Myers14. 1. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: kwallace2@umc.edu. 2. Duke Clinical Research Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina. 3. Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota. 4. Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Center for Health Promotion and Disease Prevention, UNC School of Public Health, Chapel Hill, North Carolina. 5. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 6. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. 7. Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia. 8. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan. 9. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California. 10. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts. 11. Fibroid Foundation, Bethesda, Maryland. 12. Inova Fairfax Hospital, Falls Church, Virginia. 13. Duke Clinical Research Institute; Duke University School of Medicine, Durham, North Carolina. 14. Duke Clinical Research Institute, Duke University Medical Center; and Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
Abstract
OBJECTIVE: To compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL. DESIGN: Prospective cohort study. SETTING: Eight clinical sites throughout the United States. PATIENT(S): A total of 1,113 premenopausal women with UFs who underwent hysterectomy or myomectomy as part of Comparing Options for Management: Patient-Centered Results for Uterine Fibroids. INTERVENTION(S): None. MAIN OUTCOME MEASURE (S): Self-reported HRQOL measures including Uterine Fibroid Symptom Quality of Life, the European QOL 5 Dimension Health Questionnaire, and the visual analog scale at baseline and 1-year after hysterectomy or myomectomy. RESULT (S): Hysterectomy patients were older with a longer history of symptomatic UF compared with myomectomy patients. There were no differences in baseline HRQOL. After adjustment for baseline differences between groups, compared with myomectomy, patients' HRQOL (95% confidence interval [CI], 5.4, 17.2) and symptom severity (95% CI, -16.3, -8.8) were significantly improved with hysterectomy. When stratified across race/ethnicity and age, hysterectomy had higher HRQOL scores compared with myomectomy. There was little difference in HRQOL (95% CI, 0.1 [-9.5, 9.6]) or symptom severity (95% CI, -3.4 [-10, 3.2]) between abdominal hysterectomy and abdominal myomectomy. CONCLUSION (S): HRQOL improved in all women 1 year after hysterectomy or myomectomy. Hysterectomy patients reported higher HRQOL summary scores compared with myomectomy patients. When stratified by route, minimally invasive hysterectomy had better HRQOL scores than minimally invasive myomectomy. There was little difference in scores with abdominal approaches.
OBJECTIVE: To compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL. DESIGN: Prospective cohort study. SETTING: Eight clinical sites throughout the United States. PATIENT(S): A total of 1,113 premenopausal women with UFs who underwent hysterectomy or myomectomy as part of Comparing Options for Management: Patient-Centered Results for Uterine Fibroids. INTERVENTION(S): None. MAIN OUTCOME MEASURE (S): Self-reported HRQOL measures including Uterine Fibroid Symptom Quality of Life, the European QOL 5 Dimension Health Questionnaire, and the visual analog scale at baseline and 1-year after hysterectomy or myomectomy. RESULT (S): Hysterectomy patients were older with a longer history of symptomatic UF compared with myomectomy patients. There were no differences in baseline HRQOL. After adjustment for baseline differences between groups, compared with myomectomy, patients' HRQOL (95% confidence interval [CI], 5.4, 17.2) and symptom severity (95% CI, -16.3, -8.8) were significantly improved with hysterectomy. When stratified across race/ethnicity and age, hysterectomy had higher HRQOL scores compared with myomectomy. There was little difference in HRQOL (95% CI, 0.1 [-9.5, 9.6]) or symptom severity (95% CI, -3.4 [-10, 3.2]) between abdominal hysterectomy and abdominal myomectomy. CONCLUSION (S): HRQOL improved in all women 1 year after hysterectomy or myomectomy. Hysterectomy patients reported higher HRQOL summary scores compared with myomectomy patients. When stratified by route, minimally invasive hysterectomy had better HRQOL scores than minimally invasive myomectomy. There was little difference in scores with abdominal approaches.
Authors: Kedra Wallace; Elizabeth A Stewart; Lauren A Wise; Wanda Kay Nicholson; John Preston Parry; Shuaiqi Zhang; Shannon Laughlin-Tommaso; Vanessa Jacoby; Raymond M Anchan; Michael P Diamond; Sateria Venable; Amber Shiflett; Ganesa R Wegienka; George Larry Maxwell; Daniel Wojdyla; Evan R Myers; Erica Marsh Journal: J Womens Health (Larchmt) Date: 2021-06-08 Impact factor: 2.681