Anaemia and long-term outcomes after surgical treatment of uterine fibroids: evidence from real-world data

Abstract Uterine leiomyomas are the most common benign gynaecological tumours and a major cause of heavy menstrual bleeding, frequently resulting in iron deficiency anaemia. However, the long-term cardiovascular and thromboembolic consequences of fibroid-related anaemia remain poorly understood. We conducted a retrospective cohort study using the TriNetX health research network (~ 160 million patients). Women with uterine fibroids undergoing surgical management were identified and stratified by the presence or absence of anaemia within three years before surgery. Propensity score matching (1:1) was applied to balance demographics and comorbidities. Twelve-month outcomes included all-cause mortality, myocardial infarction, stroke, atrial fibrillation/flutter, heart failure, and venous thromboembolism. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. From 83,319 eligible patients, 9,581 anaemic and 9,581 non-anaemic women were well matched. At one year, the presence of anaemia was associated with higher risks of mortality (RR 1.93, 95% CI 1.04–3.60, p = 0.03), stroke (RR 1.65, 1.05–2.60, p = 0.02), atrial fibrillation/flutter (RR 1.60, 1.03–2.48, p = 0.03), heart failure (RR 1.97, 1.43–2.70, p < 0.0001), and venous thromboembolism (RR 2.15, 1.67–2.80, p < 0.0001). No significant difference was observed for myocardial infarction (RR 1.44, 0.80–2.60, p = 0.22). The composite cardiovascular outcome was significantly elevated (HR 1.74, 95% CI 1.44–2.09, p < 0.0001). Preoperative anaemia in women undergoing fibroid surgery independently predicts adverse cardiovascular and thromboembolic events and nearly doubled 12-month mortality. Early recognition and optimisation of anaemia may improve clinical outcomes.