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Background: Uterine fibroids are extremely common and are a major cause of abnormal uterine bleeding and other gynecologic symptoms. The three main treatment options: hysterectomy, myomectomy, and uterine artery embolization (UAE) each have different implications for recovery, symptom relief, and future fertility. While guidelines emphasize for individualized, shared decision-making based on clinical factors like reproductive goals and fibroid type, prior research suggests that race/ethnicity and insurance status may also influence which treatment patients receive. Many of these studies use large administrative databases that don't capture the clinical details needed to tell whether differences in treatment reflect appropriate medical decision-making or actual disparities in care.

Objective: This study aims to examine what patient-level factors; both clinical and demographic, are associated with fibroid treatment decisions and outcomes within the UCLA Health system.

Methods: This is a retrospective cohort study using de-identified electronic health record data from the UCLA De-identified Data Repository (DDR), covering 2015–2025. We identified adult patients with a documented fibroid diagnosis (ICD-10 codes D25.0, D25.1, D25.2, and D25.9) who underwent UAE, hysterectomy, or myomectomy (identified by CPT and ICD-10-PCS codes). Patients with pregnancy-related diagnoses within 270 days of their procedure were excluded. Demographic variables include age, race/ethnicity, insurance type, and primary language. Clinical variables include fibroid subtype, BMI, and pre-procedure hemoglobin. Comorbidities were captured using a one-year look-back window. Outcomes include 90-day post-procedure complications, 30-day hospital readmissions, and repeat procedures. We will use descriptive statistics and chi-square tests to evaluate unadjusted associations, followed by multivariable logistic regression to examine whether demographic differences in treatment persist after accounting for clinical factors.

Results: The study cohort includes 6,364 patients who underwent fibroid treatment at UCLA Health between 2015 and 2025. The most common treatment was myomectomy (n=2,879, 45.2%), followed by hysterectomy (n=2,829, 44.5%), and UAE (n=656, 10.3%). Patients who underwent hysterectomy were older on average (mean age 53.6 years) compared to those who had myomectomy (42.6 years) or UAE (46.5 years). The cohort was racially and ethnically diverse, with the largest groups being White (37.3%), Hispanic or Latino (16.2%), Asian (13.9%), and Black or African American (14.2%) patients. The 30-day readmission rate was low across all groups (hysterectomy 1.3%, myomectomy 0.5%, UAE 1.2%). Ninety-day complication rates were highest in the hysterectomy group (10.2%) compared to myomectomy (4.2%) and UAE (4.7%). Repeat procedures were most common after myomectomy (11.5%) and UAE (9.9%) compared to hysterectomy (0.2%), which is expected given that hysterectomy is a definitive treatment. Formal bivariate and multivariable analyses examining associations between race/ethnicity, insurance status, and treatment selection are ongoing.

Conclusions: This study will add to the growing body of evidence on fibroid care disparities by examining treatment patterns and outcomes initially within UCLA Health and in the future expanding LA county. Early descriptive findings show notable differences in treatment distribution by age and meaningful variation in complication and repeat procedure rates across treatment types. If demographic disparities in treatment selection or outcomes are identified after accounting for clinical factors, these findings could directly inform equity-focused initiatives within UCLA Health and support future multi-center research on fibroid care.