Ilnitsky S, McClure A, Vilos G, Vilos A, AbuRafea B, Vinden C, McGee J. Complication Rates after Endometrial Ablation in Ontario: A Cohort Analysis of 76 446 Patients.
J Minim Invasive Gynecol 2021;
28:1935-1940.e4. [PMID:
33992798 DOI:
10.1016/j.jmig.2021.05.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES
Endometrial ablation (EA) is an alternative to hysterectomy for the management of heavy menstrual bleeding; however, EA is not without risk. Our objective was to determine complication rates in women undergoing EA in the province of Ontario over a 15-year time period. The primary outcome was a composite of multiple complications within 30 to 180 days of surgery. The secondary outcomes included mortality, length of hospital stay, hospital readmission, and emergency department visit within 30 days of discharge.
DESIGN
Retrospective cohort study using Cochran-Armitage test for trend.
SETTING
Administrative data from the Canadian province of Ontario, assessing patients undergoing surgery in a publicly funded healthcare system.
PATIENTS
Women in Ontario undergoing a primary EA over a 15-year time period.
INTERVENTIONS
The intervention was a primary EA.
MEASUREMENTS AND MAIN RESULTS
We assessed for genitourinary complication, fistula, gastrointestinal complication, pain, control of bleeding, blood transfusion, infectious complication, venous thromboembolism, fluid overload, thermal injury, and other injuries related to surgery. The secondary outcomes included 1-month and 6-month mortality, length of hospital stay, hospital readmission, and emergency department visit within 30 days of discharge. A total of 76 446 primary EAs were evaluated from 2002 to 2017, with the number of EAs per year increasing over the study period by 47%. Complications were seen in 4.8% of the cohort, with the complication rate being relatively stable over time. Although 6.2% of the cohort re-presented to the emergency department, <1% required readmission, and <0.05% died within 180 days. On multivariable analysis, the risk of complications increased with a preoperative diagnosis of other than bleeding (odds ratio [OR] 2.89; 95% confidence interval [CI], 2.61-3.21; p <.001), previous abdominal surgery (OR 1.42; 95% CI, 1.28-1.56; p <.001), and American Society of Anesthesiologists score 3+ (OR 1.37; 95% CI, 1.27-1.48; p <.001).
CONCLUSION
Primary EA is associated with complications in <5% of the patients, with serious complications infrequent.
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