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Complication rates after endometrial ablation in Ontario, a cohort analysis of 76 446 patients

Ilnitsky S, McClure A, Vilos G, Vilos A, AbuRafea B, Vinden C, McGee J. J Minim Invasive Gynecol. 2021; 28(11):1935-40.e4. Epub 2021 May 13. DOI: https://doi.org/10.1016/j.jmig.2021.05.003


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 after surgery. Secondary outcomes included mortality, length of stay, hospital readmission and emergency room visit within 30 days of discharge.

Design — Retrospective cohort study utilizing Cochran-Armitage test for trends.

Setting — Administrative data from the Canadian province of Ontario, assessing patients undergoing surgery in a publicly funded health care system.

Patients — Women in Ontario undergoing a primary EA over a 15 year time period.

Intervention — The intervention was a primary EA.

Measurements — 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. Secondary outcomes included one-month and six-month mortality, length of hospital stay, hospital readmission and emergency room visit within 30-days of discharge.

Main Results — A total of 76446 primary EAs were evaluated from 2002-2017, with the number of EAs/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. While 6.2% of the cohort re-presented to the ER, less than 1% required readmission and < 0.05% died within 180 days. On multivariable analysis, the risk of complication increased with a preoperative diagnosis other than bleeding (OR 2.89 (2.61,3.21) p<0.0001), previous abdominal surgery (OR 1.42(1.28,1.56) p<0.0001), and ASA 3+ (1.37 (1.27,1.48) p<0.0001).

Conclusion — Primary EA is associated with complications in less than 5% of patients, with serious complications infrequent.

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