McGee J, McClure A, Ilnitsky S, Vilos A, Abu-Rafea B, Vilos G
Facts Views Vis Obgyn. 2024 Sep;16(3):311-316. doi: 10.52054/FVVO.13.3.028.
Endometrial Ablation (EA) is an alternative to hysterectomy for the management of abnormal uterine bleeding (AUB); however, it does not eliminate the need for future surgical re-intervention.
The primary objective of this study was to establish long-term clinical outcomes including the risk of hysterectomy in women who had undergone a primary EA.
This is a retrospective population-based cohort study utilising administrative data from the Canadian province of Ontario. This study assesses patients undergoing surgery in a publicly funded health care system.
We assessed women in Ontario undergoing a primary EA over a 15-year period. The primary outcome was hysterectomy within 5 years of primary EA. Secondary outcomes included myomectomy and repeat EA. All outcomes were also reported for 1, 3, 5, 10 and 15 years of follow-up. Logistic regression was used to establish predictors of hysterectomy within 5 years of primary EA.
A total of 76,446 primary EAs were evaluated from 2002-2017, with 16,480 (21.56%) undergoing a subsequent surgical intervention. The average age of primary EA was 43.8 (+/- 6.3) years. Within 5 years, the evaluable cohort was 52,464, with 8,635 (16.46%) of women having proceeded to hysterectomy, 664 (1.27%) to myomectomy, and 2,468 (2.8%) to repeat ablation. By 15-years follow-up, the evaluable cohort was 1,788, with 28.75% had undergone a hysterectomy, 2.01% a myomectomy, and 5.20% a repeat EA. On logistic regression analysis, advancing age at time of EA was associated with significantly decreased odds of hysterectomy (OR=0.94, 95% CI 0.935-0.944, p<.0001) as was increasing surgical experience (OR=0.997, 95% CI 0.994-1.000, p=.022). Conversely, complex diagnosis (OR=1.102, 95% CI 1.042-1.164, p<.0001) and previous abdominal surgery (OR=1.288, 95% CI 1.222-1.357, p<0.0001) were associated with increased risk of subsequent hysterectomy.
Primary EA is associated with a high risk of progression to subsequent hysterectomy or other surgical intervention, without evidence of plateau of risk with long term follow-up.
WHAT IS NEW?: This study has the longest follow-up assessing hysterectomy outcomes in women undergoing a primary EA, with 28.75% of women having undergone a hysterectomy within 15 years of their EA.
子宫内膜消融术（EA）是治疗异常子宫出血（AUB）的子宫切除术替代方案；然而，它并不能消除未来再次手术干预的必要性。
本研究的主要目的是确定接受初次EA的女性的长期临床结局，包括子宫切除术风险。
这是一项基于人群的回顾性队列研究，利用了加拿大安大略省的行政数据。本研究评估了在公共资助医疗系统中接受手术的患者。
我们评估了安大略省15年间接受初次EA的女性。主要结局是初次EA后5年内的子宫切除术。次要结局包括肌瘤切除术和重复EA。所有结局也报告了1、3、5、10和15年的随访情况。采用逻辑回归确定初次EA后5年内子宫切除术的预测因素。
2002年至2017年共评估了76446例初次EA，其中16480例（21.56%）接受了后续手术干预。初次EA的平均年龄为43.8（±6.3）岁。5年内，可评估队列有52464例，其中8635例（16.46%）女性进行了子宫切除术，664例（1.27%）进行了肌瘤切除术，2468例（2.8%）进行了重复消融术。到15年随访时，可评估队列有1788例，其中28.75%进行了子宫切除术，2.01%进行了肌瘤切除术，5.20%进行了重复EA。逻辑回归分析显示，EA时年龄增长与子宫切除术几率显著降低相关（OR = 0.94，95% CI 0.935 - 0.944，p <.000 < span="">1），手术经验增加也相关（OR = 0.997，95% CI 0.994 - 1.000，p =.022）。相反，复杂诊断（OR = 1.102，95% CI 1.042 - 1.164，p <.000 < span="">1）和既往腹部手术（OR = 1.288，95% CI 1.222 - 1.357，p < 0.000 < span="">1）与后续子宫切除术风险增加相关。
初次EA与进展为后续子宫切除术或其他手术干预的高风险相关，长期随访无风险平稳的证据。
本研究对接受初次EA的女性子宫切除术结局进行了最长时间的随访，28.75%的女性在EA后15年内进行了子宫切除术。
