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Rates of subsequent surgery following endometrial ablation among E nglish women with menorrhagia: population‐based cohort study
Author(s) -
BansiMatharu L,
GurolUrganci I,
Mahmood TA,
Templeton A,
Meulen JH,
Cromwell DA
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12319
Subject(s) - medicine , endometrial ablation , hysterectomy , hazard ratio , cohort , gynecology , population , obstetrics , retrospective cohort study , cohort study , uterine fibroids , surgery , confidence interval , environmental health
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 E nglish N ational H ealth S ervice. Population A cohort of 114 910 women who had EA for HMB between January 2000 and December 2011. Methods Multiple C ox 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.