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

• Published in: BJOG : an international journal of obstetrics and gynaecology 2013-11, Vol.120 (12), p.1500-1507
• Main Authors: Bansi‐Matharu, L, Gurol‐Urganci, I, Mahmood, TA, Templeton, A, Meulen, JH, Cromwell, DA
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Endometrial ablation; Endometrial Ablation Techniques - statistics & numerical data; England; Female; Gynecology; heavy menstrual bleeding; Humans; hysterectomy; Hysterectomy - statistics & numerical data; Kaplan-Meier Estimate; Leiomyoma - complications; Medical procedures; Menorrhagia - surgery; Microwaves - therapeutic use; Middle Aged; Polyps - complications; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Surgery; Uterine Cervical Diseases - complications; Young Adult
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.12319

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.