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

Wanda K. Nicholson, Ganesa Wegienka, Shuaiqi Zhang, Kedra Wallace, Elizabeth Stewart, Shannon Laughlin-Tommaso, Laine Thomas, Vanessa L. Jacoby, Erica E. Marsh, Lauren Wise, Bijan J. Borah, James Spies, Sateria Venable, Raymond M. Anchan, G. Larry Maxwell, Michael Diamond, Barbara Lytle, Evan R. Myers

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)261-269
Number of pages9
JournalObstetrics and gynecology
Volume134
Issue number2
DOIs
StatePublished - Aug 1 2019

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Uterine Myomectomy
Leiomyoma
Hysterectomy
Quality of Life
Registries
Social Adjustment
Propensity Score
Consciousness

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas. / Nicholson, Wanda K.; Wegienka, Ganesa; Zhang, Shuaiqi; Wallace, Kedra; Stewart, Elizabeth; Laughlin-Tommaso, Shannon; Thomas, Laine; Jacoby, Vanessa L.; Marsh, Erica E.; Wise, Lauren; Borah, Bijan J.; Spies, James; Venable, Sateria; Anchan, Raymond M.; Larry Maxwell, G.; Diamond, Michael; Lytle, Barbara; Myers, Evan R.

In: Obstetrics and gynecology, Vol. 134, No. 2, 01.08.2019, p. 261-269.

Research output: Contribution to journalArticle

Nicholson, WK, Wegienka, G, Zhang, S, Wallace, K, Stewart, E, Laughlin-Tommaso, S, Thomas, L, Jacoby, VL, Marsh, EE, Wise, L, Borah, BJ, Spies, J, Venable, S, Anchan, RM, Larry Maxwell, G, Diamond, M, Lytle, B & Myers, ER 2019, 'Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas', Obstetrics and gynecology, vol. 134, no. 2, pp. 261-269. https://doi.org/10.1097/AOG.0000000000003354
Nicholson, Wanda K. ; Wegienka, Ganesa ; Zhang, Shuaiqi ; Wallace, Kedra ; Stewart, Elizabeth ; Laughlin-Tommaso, Shannon ; Thomas, Laine ; Jacoby, Vanessa L. ; Marsh, Erica E. ; Wise, Lauren ; Borah, Bijan J. ; Spies, James ; Venable, Sateria ; Anchan, Raymond M. ; Larry Maxwell, G. ; Diamond, Michael ; Lytle, Barbara ; Myers, Evan R. / Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas. In: Obstetrics and gynecology. 2019 ; Vol. 134, No. 2. pp. 261-269.
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AU - Zhang, Shuaiqi

AU - Wallace, Kedra

AU - Stewart, Elizabeth

AU - Laughlin-Tommaso, Shannon

AU - Thomas, Laine

AU - Jacoby, Vanessa L.

AU - Marsh, Erica E.

AU - Wise, Lauren

AU - Borah, Bijan J.

AU - Spies, James

AU - Venable, Sateria

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N2 - 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.

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