Design: A retrospective analysis of interventions for fibroids using NHS digital hospital episode statistics data.

Setting: All UK NHS hospitals offering treatment for fibroids.

Patients or Participants: All women undergoing treatment for fibroids in 2018/19.

Interventions: Type of treatments undertaken for fibroids (including hysterectomy, myomectomy, embolisation), hospital location, BSGE accreditation and case volume. Comparison between centres performing <5 myomectomies per year and >25 per year was performed.

Measurements and Main Results: There were 27,892 interventions for fibroids: 12,008 hysterectomies (43%), 1666 uterine artery embolisations (5.9%), 2970 myomectomies (805 laparoscopic and 2165 open). the availability of myomectomy varied across the UK and between high and low volume hospitals. In 57 BSGE centres the average number of laparoscopic myomectomies was 11 (range 0-105). 7 BSGE centres performed <5 laparoscopic myomectomies and 7 performed >25. Length of stay was inversely proportional to number of myomectomies. London and the BSGE centres were the highest volume centres for both open and laparoscopic myomectomy. Within some centres, laparoscopic myomectomy was not performed.

Conclusion: There is regional variability in high and low performance hospitals. Most myomectomies are performed in London, and BSGE centres performed more laparoscopic myomectomies but there were still centres not performing any. For women to have equitable access they need to know where services exist. We advocate prospective data collection similar to those in USA (COMPARE-UF) and Canada (CAPTURE) to allow patients and clinicians to make informed and appropriate choices.