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Predictors of Subsequent Surgery for Uterine Leiomyomata After Abdominal Myomectomy

From the Center for Uterine Fibroids and Ob/Gyn Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

Address reprint requests to: Elizabeth A. Stewart, MD, Brigham and Women’s Hospital, Center for Uterine Fibroids, 75 Francis Street, Boston, MA 02115; E-mail: eastewart{at}partners.org.

OBJECTIVE: To study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy.

METHODS: We followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 ± 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery.

RESULTS: Women with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5).

CONCLUSION: Women with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth.

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