Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study.

Abstract

OBJECTIVE:

To assess the risk of further surgery amongst women who had an initial endometrial ablation (EA) for the treatment of heavy menstrual bleeding (HMB).

DESIGN:

A retrospective cohort study using a national administrative database.

SETTING:

Population-based study of hospital care in the English National Health Service.

POPULATION:

A cohort of 114,910 women who had EA for HMB between January 2000 and December 2011.

METHODS:

Multiple Cox regressions were performed to identify the risks of a further procedure, adjusted for age, social deprivation, year and type of initial EA, and presence of fibroids/polyps.

MAIN OUTCOME MEASURES:

Time to repeat EA or hysterectomy after initial surgery.

RESULTS:

Of 114,910 women undergoing EA, 16.7% had at least one subsequent procedure within 5 years. Higher rates of subsequent surgery were associated with younger age at initial EA, with women aged under 35 years having an adjusted hazard ratio of 2.83 (95% CI 2.67-2.99), compared with women aged over 45 years. Women who had radiofrequency ablation were less likely to have subsequent surgery as compared with first-generation techniques (HR 0.69, 95% CI 0.63-0.76). The rate of a subsequent hysterectomy within 5 years was 13.5%. Younger women (OR 0.59, 95% CI 0.51-0.69) and those who had balloon, microwave, or radiofrequency ablation were less likely to have a second EA procedure, rather than a hysterectomy.

CONCLUSIONS:

One in six women have further surgery after EA for HMB, which is a higher rate than reported in clinical trials. This risk of further surgery decreases with age.

• Authors: L Bansi-Matharu, I Gurol-Urganci, T A Mahmood, A Templeton, J H van der Meulen, D A Cromwell
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 120 Issue 12 Pg. 1500-7 (Nov 2013) ISSN: 1471-0528 [Electronic] England
• PMID: 23786246 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 RCOG.

Topics

• Adolescent
• Adult
• Aged
• Endometrial Ablation Techniques (statistics & numerical data)
• England
• Female
• Humans
• Hysterectomy (statistics & numerical data)
• Kaplan-Meier Estimate
• Leiomyoma (complications)
• Menorrhagia (surgery)
• Microwaves (therapeutic use)
• Middle Aged
• Polyps (complications)
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Risk Factors
• Uterine Cervical Diseases (complications)
• Young Adult