title: Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study.
abstract: OBJECTIVE
  To investigate the readmission experience of a large national prospective cohort of women up to 5 years after undergoing either transcervical resection of the endometrium (TCRE) or hysterectomy to assess reasons for readmission and whether TCRE can be viewed as a definitive substitute for hysterectomy.
  
  
  METHODS
  Data are from the VALUE/MISTLETOE prospective national cohort studies of hysterectomy and TCRE respectively. 5294 women who underwent hysterectomy for dysfunctional uterine bleeding in 1994/5 and 4032 women who underwent TCRE in 1993/4 and who responded to postal questionnaires were included. Surgeons gathered operative details. Women completed postal follow up questionnaires at 3 and 5 years after surgery asking about readmission to hospital and reasons for readmission. Adjusted proportional hazard ratios were calculated for likelihood of readmission in each category comparing types of surgery.
  
  
  RESULTS
  41.7% of women undergoing hysterectomy and 44.6% of women undergoing TCRE experienced one or more readmissions to hospital overall within 5 years (adjusted hazard ratio for all readmissions (AHR) 0.87 (95% confidence interval (CI) 0.80 to 0.95)). 12.6% of hysterectomy patients and 30.3% of TCRE patients were readmitted for gynaecological reasons (AHR 0.40 (95% CI 0.33 to 0.48)). Rates of readmission for gynaecological reasons were similar up to 6 months but were markedly reduced for hysterectomy compared with TCRE patients towards the end of the follow up period (AHR for readmission at 3-5 years 0.28 (95% CI 0.20 to 0.39)).
  
  
  CONCLUSIONS
  There are differences in the pattern of readmission to hospital after hysterectomy and TCRE for dysfunctional uterine bleeding. Women undergoing a hysterectomy are less likely to be readmitted to hospital up to 5 years after their operation overall, and are significantly less likely to be readmitted for reasons related to their operation, particularly for gynaecological reasons. Hysterectomy appears to be a more definitive operation. The different options for surgery for dysfunctional uterine bleeding are not interchangeable; they represent different patterns of care. Information should be available to women and practitioners to inform choices between these options.
authors.affiliation: Public Health and Policy Research Unit, Barts and the London Queen Mary's School of Medicine and Dentistry, University of London, London, UK. a.e.clarke@qmul.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: A
authors.initials: A
authors.lastname: Judge
authors.forename: A
authors.initials: A
authors.lastname: Herbert
authors.forename: K
authors.initials: K
authors.lastname: McPherson
authors.forename: S
authors.initials: S
authors.lastname: Bridgman
authors.forename: M
authors.initials: M
authors.lastname: Maresh
authors.forename: C
authors.initials: C
authors.lastname: Overton
authors.forename: D
authors.initials: D
authors.lastname: Altman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010359:Patient Readmission; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom