By: Jean Johnson for Fibroids1
While uterine artery embolization (UAE) is done in both inpatient and outpatient settings, Canadian researchers at the University of Toronto recommend that specialists perform UAE as an outpatient procedure.
|Physicians can use ultrasound and magnetic resonance imaging (MRI) tests to help confirm the presence of fibroids in women who have heavy bleeding.|
If women are interested in uterine artery embolization (UAE) as a treatment option, their gynecologist will recommend that they consult an interventional radiologist who specializes in UAE.
The recovery time for UAE is several days to a week, which is considerably shorter than the weeks and months it takes to recover from major abdominal surgeries like myomectomy and hysterectomy
To reach their conclusion, Mark O. Baerlocher, MD and his colleagues surveyed 100 women, 82 of whom underwent UAE as hospitalized patients and 18 of whom were treated in outpatient settings. Baerlocher’s team analyzed their data in terms of cost, safety, and patient satisfaction. Their results were published in the April 2006 issue of the Canadian Association of Radiology Journal.
“I’m so grateful that this data has come out even though it’s in Canadian dollars,” 26-year-old Jessica McCarthy of Seattle said about the study. “Not for myself, but for a friend of mine who has fibroids and has been waffling about having them treated. She’s in her late 30s and has two children, which she says is enough. So since she’s not worried about fertility she’s been leaning toward embolization over full-blown surgery.
“I’m not sure if that’s what’s holding her up – maybe her doctor has recommended waiting for some reason that she hasn’t shared with me,” said McCarthy. “But at least I can take her this article after it’s published on the website [Fibroids1.com]. At least I can show her what the Canucks are thinking.
“I think that once she really realizes she can have the embolization safely on an out-patient basis, she might be more ready to go ahead with it and get free of her symptoms. She never did like hospitals very much, but then most of us don’t, really.”
Treating heavy uterine bleeding via catheter-driven embolization began 25 years ago when the procedure was used to control postpartum hemorrhage, or excessive bleeding after childbirth. By 1995, the treatment had evolved and experts on the circulation system called interventional radiologists were applying the technique to shrink uterine fibroids.
Estimates compiled by the Society of Interventional Radiologists are that by the year 2000, 10,000 uterine artery embolizations (UAE) – also called uterine fibroid embolizations or UFE – had been performed worldwide.
Large multiple studies have demonstrated that UAE is safe and beneficial in more than 85 percent of patients treated. “Its clinical success rate of greater than 85 percent combined with a low complication rate and short post-procedural recovery time,” writes Baerlocher et al, “make the procedure attractive when compared with surgical or even laparoscopic myomectomy.” The myomectomy, which removes the fibroids and leaves the uterus intact, has traditionally been done via major surgery and large incisions in the abdomen. More recently, myomectomies using small keyhole incisions are gaining recognition as an alternate approach in appropriate patient candidates.
Baerlocher and his team further state that, “Another trend in medicine is a shift toward ambulatory care, both to increase patient satisfaction and to reduce health care costs.” They point out, however, that for physicians to manage UAE patients in outpatient settings, they must be able to manage common post-procedural symptoms as well as any complications that might arise.
The most common symptoms women experience after UAE are “pelvic pain, nausea, vomiting, fever, low-grade leukocytosis, and malaise,” a group of symptoms that are otherwise known as post-embolization syndrome. Consequently, Baerlocher observes, “Most centers currently admit uterine fibroid embolization patients for 24 to 48 hours.”
Results: Safety, Costs, Patient Satisfaction
“We did not find any statistically significant difference between inpatient and outpatient UAE on any of the patient variables measured, including present complaints, post-procedural symptoms, patient satisfaction, and readmission or complication rates,” the authors write. Additionally they found costs over $1,000 less when women with fibroids are treated with UAE as outpatients.
Specifically, “In Ontario, inpatient UAE costs per patient totaled $3216.22, whereas outpatient costs totaled $2194.53, which represents a 31.8 percent cost reduction.”