Short-Term Safety of Uterine Fibroid Embolization Versus Myomectomy Subtypes: A Propensity-Weighted National Claims...

Background: Uterus-preserving treatments for fibroids include uterine fibroid embolization (UFE) and myomectomy. Prior studies have frequently pooled distinct myomectomy approaches (abdominal, laparoscopic, hysteroscopic), potentially confounding comparisons. Objective: To compare short-term safety outcomes between UFE and myomectomy, analyzing myomectomy both overall and stratified by procedural subtype. Methods: This retrospective study used a national commercial claims database (MarketScan) to identify women 25-50 years old who underwent outpatient UFE or myomectomy in calendars years 2013 through 2025 as their first fibroid-directed procedure. UFE was compared with abdominal, laparoscopic, and hysteroscopic myomectomy individually; with pooled abdominal and laparoscopic myomectomy; and with all three myomectomy subtypes pooled, using inverse probability of treatment weighting accounting for age, treatment year, comorbidities, and healthcare utilization measures. The primary outcome was occurrence of a 30-day composite major adverse event (MAE). Additional 30-day secondary outcomes were recorded. Results: The study sample included 59,484 women (median age, 42 years; UFE [n=10,507], abdominal myomectomy [n=7286], laparoscopic myomectomy [n=13,341], hysteroscopic myomectomy [n=28,350]). The likelihood of 30-day composite MAEs was significantly lower for UFE (2.5%) than for abdominal myomectomy (5.4%; OR=0.44), laparoscopic myomectomy (2.5%; OR=0.77), and pooled abdominal and laparoscopic myomectomy (3.5%; OR=0.60); significantly higher for UFE than for hysteroscopic myomectomy (1.0%; OR=1.95); and not significantly different between UFE and pooled all-subtype myomectomy (2.1%; OR=1.14). The likelihood of 30-day hospital readmission was significantly lower for UFE than for abdominal myomectomy (OR=0.19), pooled abdominal and laparoscopic myomectomy (OR=0.37), and pooled all sub-type myomectomy (OR=0.84); significantly higher for UFE than for hysteroscopic myomectomy (OR=2.50); and not significantly different between UFE and laparoscopic myomectomy (OR=0.88). The likelihood of 30-day bleeding events was significantly lower for UFE than for abdominal (OR=0.23) or laparoscopic myomectomy (OR=0.61) and significantly higher for UFE than for hysteroscopic myomectomy (OR=1.34). The likelihood of a 30-day ED visit was significantly higher for UFE than for all myomectomy comparators (OR=1.30-2.38). Conclusion: UFE demonstrated short-term safety advantages relative to incisional myomectomy, although this difference was more pronounced for the abdominal than laparoscopic approach. Overall safety advantages were not observed relative to hysteroscopic myomectomy. Clinical Impact: Pooling myomectomy subtypes can obscure clinically meaningful safety differences for UFE.