Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding

retrospective analysis of hospital episode statistics in Scotland

K Cooper, A J Lee, P Chien, E A Raja, V Timmaraju, S Bhattacharya

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding.

Design Population-based retrospective cohort study.

Setting Scottish hospitals between 1989 and 2006.

Population or sample  Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006.

Methods Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile.

Main outcome measures Further gynaecological surgery and gynaecological cancer in women.

Results A total of 37 120 women had a hysterectomy, 11 299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39).

Conclusions Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.
Original languageEnglish
Pages (from-to)1171-1179
Number of pages9
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume118
Issue number10
Early online date31 May 2011
DOIs
Publication statusPublished - Sep 2011

Fingerprint

Endometrial Ablation Techniques
Scotland
Hysterectomy
Hemorrhage
Pelvic Floor
Confidence Intervals
Vaginal Hysterectomy
Gynecologic Surgical Procedures
Stress Urinary Incontinence
Suburethral Slings
Neoplasms
Information Services
Prolapse
Population

Keywords

  • endometrial ablation
  • endometrial cancer
  • heavy menstrual bleeding
  • hysterectomy
  • pelvic floor repair
  • stress urinary incontinence

Cite this

@article{0761a0ba4d55418eabd171ecf095079f,
title = "Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding: retrospective analysis of hospital episode statistics in Scotland",
abstract = "Objective To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding. Design Population-based retrospective cohort study. Setting Scottish hospitals between 1989 and 2006. Population or sample  Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006. Methods Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile. Main outcome measures Further gynaecological surgery and gynaecological cancer in women. Results A total of 37 120 women had a hysterectomy, 11 299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95{\%} confidence interval (95{\%} CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95{\%} CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95{\%} CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57{\%} and n = 130, 1.15{\%} in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95{\%} CI, 0.93-1.39). Conclusions Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.",
keywords = "endometrial ablation, endometrial cancer, heavy menstrual bleeding, hysterectomy, pelvic floor repair, stress urinary incontinence",
author = "K Cooper and Lee, {A J} and P Chien and Raja, {E A} and V Timmaraju and S Bhattacharya",
note = "{\circledC} 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology {\circledC} 2011 RCOG.",
year = "2011",
month = "9",
doi = "10.1111/j.1471-0528.2011.03011.x",
language = "English",
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publisher = "John Wiley & Sons, Ltd (10.1111)",
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TY - JOUR

T1 - Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding

T2 - retrospective analysis of hospital episode statistics in Scotland

AU - Cooper, K

AU - Lee, A J

AU - Chien, P

AU - Raja, E A

AU - Timmaraju, V

AU - Bhattacharya, S

N1 - © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

PY - 2011/9

Y1 - 2011/9

N2 - Objective To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding. Design Population-based retrospective cohort study. Setting Scottish hospitals between 1989 and 2006. Population or sample  Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006. Methods Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile. Main outcome measures Further gynaecological surgery and gynaecological cancer in women. Results A total of 37 120 women had a hysterectomy, 11 299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39). Conclusions Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.

AB - Objective To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding. Design Population-based retrospective cohort study. Setting Scottish hospitals between 1989 and 2006. Population or sample  Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006. Methods Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile. Main outcome measures Further gynaecological surgery and gynaecological cancer in women. Results A total of 37 120 women had a hysterectomy, 11 299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39). Conclusions Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.

KW - endometrial ablation

KW - endometrial cancer

KW - heavy menstrual bleeding

KW - hysterectomy

KW - pelvic floor repair

KW - stress urinary incontinence

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DO - 10.1111/j.1471-0528.2011.03011.x

M3 - Article

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JO - BJOG-An International Journal of Obstetrics and Gynaecology

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