Perioperative predictors of successful hysteroscopic endometrial ablation.
OBJECTIVE
To determine which perioperative factors influence the success of hysteroscopic endometrial ablation in patients with menorrhagia.


METHODS
A longitudinal study of 128 women who underwent hysteroscopic endometrial ablation or resection. Clinical data included age, uterine size, the presence of intramural or submucosal myomas and polyps, and length of follow-up from initial hysteroscopic ablation to re-ablation or hysterectomy ('failure'). Kaplan-Meier survival analysis, log-rank tests and Cox proportional hazard regression were used to evaluate the equality of survival distributions and to model the overall effects of the various predictor variables on surgical outcomes.


RESULTS
Patients were followed for a median time of 44 months. Thirteen women (10.2%) underwent a second operative procedure. Multivariate analysis identified submucosal myoma as a statistically significant positive predictor of the risk of failure [hazard ratio (HR) 5.22, 95% confidence interval (CI) = 1.63, 16.73)]. Older age was associated with a marginally lower risk of subsequent surgery (HR 0.90 per additional year of age, 95% CI = 0.81, 1.00).


CONCLUSIONS
The presence of submucosal myoma increases the risk of subsequent surgery in patients undergoing endometrial ablation.
Gemer
Ofer
O
Department of Obstetrics and Gynecology Barzilai Medical Center, Ashkelon, Israel. gemer@barzi.health.gov.il
Kruchkovich
Jenya
J
Huerta
Michael
M
Kapustian
Viki
V
Kroll
Dov
D
Anteby
Eyal
E
D000328:Adult; D017115:Catheter Ablation; D004715:Endometriosis / Q000601:surgery; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000601:surgery; D008137:Longitudinal Studies; D008875:Middle Aged; D011237:Predictive Value of Tests; D012086:Reoperation; D016896:Treatment Outcome; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000601:surgery*; D014599:Uterus / Q000000981:diagnostic imaging / Q000473:pathology