Cardiometabolic Outcomes After Fibroid Surgery: Hysterectomy vs Uterine Preservation

A retrospective analysis of U.S. administrative claims examined whether 10-year cardiometabolic diagnoses differed by management approach among privately insured women with uterine fibroids.

Using the Merative MarketScan database, the authors compared women who underwent hysterectomy, those who had uterine-preserving myomectomy, and those who did not undergo surgery. The report framed this as an observational comparison across three groups over a decade after fibroid diagnosis.

The cohort included women aged 18–55 with a fibroid diagnosis in 2010 or 2011 and 10 years of continuous enrollment (34,722 patients): 8,196 underwent hysterectomy within 365 days, 1,351 underwent myomectomy within 365 days, and 25,175 had no surgery. Outcomes captured in claims included incident coronary artery disease, congestive heart failure, cardiac arrhythmia, stroke, hypertension, hyperlipidemia, type II diabetes, and peripheral artery disease. For between-group comparisons, the authors reported age-adjusted, comorbidity-matched multivariable logistic regression models and presented odds ratios for each outcome using pairwise contrasts across the three strategies.

Compared with no surgery, the hysterectomy group showed higher age-adjusted odds for stroke (aOR 1.11), hypertension (aOR 1.14), hyperlipidemia (aOR 1.14), and type II diabetes (aOR 1.20). In the same models, the authors reported no statistically significant differences between hysterectomy and no surgery for coronary artery disease, congestive heart failure, cardiac arrhythmia, or peripheral artery disease. These findings were presented as associations in an insured claims cohort over 10 years rather than as causal effects.

For myomectomy versus no surgery, the authors reported no statistically significant adjusted differences across the eight cardiometabolic outcomes. In a direct comparison of the two surgical groups, hysterectomy versus myomectomy was associated with higher adjusted odds of hyperlipidemia (OR 1.26), while the other outcomes were not significantly different. In this analysis, myomectomy versus no surgery was reported as not significantly different across outcomes, whereas hysterectomy versus no surgery was associated with higher odds for stroke, hypertension, hyperlipidemia, and type II diabetes.

When hysterectomy included concomitant adnexal removal, the authors reported higher adjusted odds versus no surgery for coronary artery disease (OR 1.21), stroke (OR 1.15), hypertension (OR 1.29), hyperlipidemia (OR 1.28), and type II diabetes (OR 1.37). Within the hysterectomy group, outcomes did not significantly differ between ovary-sparing hysterectomy and hysterectomy with oophorectomy, and the authors stated that ovarian retention did not appear protective in this cohort.

The authors also noted limitations typical of claims-based retrospective analyses, including potential coding errors, limited demographic detail (including no race data), restriction to privately insured individuals, and inability to draw causal inferences. Overall, the report described differences in adjusted odds of several cardiometabolic diagnoses over 10 years that varied by surgical exposure and adnexal management.

Key Takeaways:

• In this MarketScan claims cohort, hysterectomy versus no surgery was associated with higher age-adjusted odds of stroke, hypertension, hyperlipidemia, and type II diabetes; CAD, CHF, cardiac arrhythmia, and peripheral artery disease were reported as not significantly different.
• Myomectomy versus no surgery was reported as not significantly different across the eight outcomes, and the hysterectomy-versus-myomectomy comparison showed a statistically significant difference only for hyperlipidemia.
• Hysterectomy with concomitant adnexal removal versus no surgery was associated with higher adjusted odds for multiple outcomes, and ovarian conservation within hysterectomy was reported as not significantly changing cardiometabolic outcomes.