title: Outcomes following hysterectomy or endometrial ablation for heavy menstrual bleeding: retrospective analysis of hospital episode statistics in Scotland.
abstract: OBJECTIVE
  To determine the risk of further gynaecological surgery and gynaecological cancer following hysterectomy and endometrial ablation in women with heavy menstrual bleeding.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Scottish hospitals between 1989 and 2006. Population or sample Scottish women treated with hysterectomy or endometrial ablation for heavy menstrual bleeding between 1989 and 2006.
  
  
  METHODS
  Anonymised data collected by the Scottish Information Services Division were analysed using appropriate methods across the hysterectomy and endometrial ablation groups. Cox proportional hazards regression analysis was used to examine the survival experience for different surgical outcomes after adjustment for age, year of primary operation and Carstairs quintile.
  
  
  METHODS
  Further gynaecological surgery and gynaecological cancer in women.
  
  
  RESULTS
  A total of 37,120 women had a hysterectomy, 11,299 women underwent endometrial ablation without a subsequent hysterectomy and 2779 women underwent endometrial ablation followed by a subsequent hysterectomy. The median (interquartile range) duration of follow-up was 11.6 years (7.9, 14.8) and 6.2 years (2.7, 10.8) in the hysterectomy and endometrial ablation (without hysterectomy) cohorts, respectively. Compared with women who underwent hysterectomy, those who underwent ablation were less likely to need pelvic floor repair [adjusted hazards ratio, 0.62; 95% confidence interval (95% CI), 0.50, 0.77] or tension-free vaginal tape surgery for stress urinary incontinence (adjusted hazards ratio, 0.55; 95% CI, 0.41, 0.74). Abdominal hysterectomy was associated with a lower chance than vaginal hysterectomy of pelvic floor repair surgery (hazards ratio, 0.54; 95% CI, 0.45, 0.64). Overall, the number of women diagnosed with cancer was small, the largest group being breast cancer (n = 584, 1.57% and n = 130, 1.15% in the hysterectomy and endometrial ablation groups respectively; adjusted hazards ratio, 1.14; 95% CI, 0.93-1.39).
  
  
  CONCLUSIONS
  Hysterectomy is associated with a higher risk than endometrial ablation of surgery for pelvic floor repair and stress urinary incontinence. Surgery for pelvic floor prolapse is more common after vaginal than abdominal hysterectomy.
authors.affiliation: Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: K
authors.initials: K
authors.lastname: Cooper
authors.forename: Aj
authors.initials: A
authors.lastname: Lee
authors.forename: P
authors.initials: P
authors.lastname: Chien
authors.forename: Ea
authors.initials: E
authors.lastname: Raja
authors.forename: V
authors.initials: V
authors.lastname: Timmaraju
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
mesh_terms: D000328:Adult; D015331:Cohort Studies; D055356:Endometrial Ablation Techniques; D005260:Female; D005833:Genital Neoplasms, Female / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D007045:Hysterectomy, Vaginal; D008595:Menorrhagia / Q000601:surgery*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology