Baseline cardiovascular risk before myomectomy versus hysterectomy for fibroids

We aimed to determine whether baseline cardiovascular disease (CVD) risk factors are significantly different between patients who undergo myomectomy versus hysterectomy for treatment of fibroids.

This is a retrospective cohort study from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) retrospective database for years 2015-2023. The primary outcome was hysterectomy for fibroids versus myomectomy. Multivariate logistic regression stratified by age group was used to evaluate the association between the primary outcome and CVD risk factors, including obesity, tobacco use disorder, diabetes requiring oral agents or insulin, hypertension requiring medications, and race and CVD risk.

A total of 128 130 patients were identified, of whom 39 225 underwent myomectomy and 88 905 underwent hysterectomy. In multivariable analysis, patients undergoing hysterectomy remained significantly more likely to be living with obesity (adjusted odds ratio [aOR] 1.65, 95% confidence interval [CI] 1.59-1.71, P < 0.001), to have used tobacco within the year before surgery (aOR 1.81, 95% CI 1.72-1.91, P < 0.001), to have hypertension (aOR 1.44, 95% CI 1.38-1.51, P < 0.001), to have no significant association with diabetes (aOR 1.04, 95% CI 0.97-1.12, P = 0.28), and to have an inverse association with race and ethnicity categories associated with cardiovascular risk (aOR of hysterectomy 0.51, 95% CI 0.50-0.53, P < 0.001). The associations with obesity, tobacco use, hypertension, and race were significantly stronger in younger age groups.

This large retrospective NSQIP cohort demonstrates that patients undergoing hysterectomy for uterine fibroids have significantly higher baseline cardiovascular risk compared to those undergoing myomectomy, with differences most pronounced in younger patients.