Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors).
Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)..
J Minim Invasive Gynecol. 2021 Nov;28(11):1935-1940.e4. doi: 10.1016/j.jmig.2021.05.003. Epub 2021 May 13.
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.
Retrospective cohort study using Cochran-Armitage test for trend.
Administrative data from the Canadian province of Ontario, assessing patients undergoing surgery in a publicly funded healthcare system.
Women in Ontario undergoing a primary EA over a 15-year time period.
The intervention was a primary EA.
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).
Primary EA is associated with complications in <5% of the patients, with serious complications infrequent.
子宫内膜切除术（EA）是治疗月经过多的一种替代子宫切除术的方法；然而，它并非没有风险。我们的目的是确定在安大略省进行 EA 的女性在 15 年时间内的并发症发生率。主要结果是手术 30 至 180 天内的多种并发症的综合结果。次要结果包括 30 天内的死亡率、住院时间、医院再入院和急诊就诊。
使用 Cochran-Armitage 趋势检验进行回顾性队列研究。
加拿大安大略省的行政数据，评估在公共资助的医疗保健系统中接受手术的患者。
在 15 年时间内接受原发性 EA 的安大略省妇女。
干预措施是原发性 EA。
我们评估了泌尿生殖系统并发症、瘘管、胃肠道并发症、疼痛、出血控制、输血、感染性并发症、静脉血栓栓塞、液体过载、热损伤和与手术相关的其他损伤。次要结果包括 1 个月和 6 个月的死亡率、住院时间、30 天内的医院再入院和急诊就诊。从 2002 年到 2017 年，共评估了 76446 例原发性 EA，研究期间每年进行的 EA 数量增加了 47%。该队列中有 4.8%的患者出现并发症，并发症发生率随时间相对稳定。尽管该队列中有 6.2%的患者再次到急诊就诊，但不到 1%的患者需要再入院，不到 0.05%的患者在 180 天内死亡。多变量分析显示，术前诊断为非出血（比值比 [OR] 2.89；95%置信区间 [CI]，2.61-3.21；p<.001）、既往腹部手术（OR 1.42；95%CI，1.28-1.56；p<.001）和美国麻醉师协会评分 3+（OR 1.37；95%CI，1.27-1.48；p<.001）的患者并发症风险增加。
原发性 EA 导致 <5%的患者出现并发症，严重并发症罕见。
