title: Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study.
abstract: OBJECTIVE
  To assess the risk of further surgery amongst women who had an initial endometrial ablation (EA) for the treatment of heavy menstrual bleeding (HMB).
  
  
  METHODS
  A retrospective cohort study using a national administrative database.
  
  
  METHODS
  Population-based study of hospital care in the English National Health Service.
  
  
  METHODS
  A cohort of 114,910 women who had EA for HMB between January 2000 and December 2011.
  
  
  METHODS
  Multiple Cox regressions were performed to identify the risks of a further procedure, adjusted for age, social deprivation, year and type of initial EA, and presence of fibroids/polyps.
  
  
  METHODS
  Time to repeat EA or hysterectomy after initial surgery.
  
  
  RESULTS
  Of 114,910 women undergoing EA, 16.7% had at least one subsequent procedure within 5 years. Higher rates of subsequent surgery were associated with younger age at initial EA, with women aged under 35 years having an adjusted hazard ratio of 2.83 (95% CI 2.67-2.99), compared with women aged over 45 years. Women who had radiofrequency ablation were less likely to have subsequent surgery as compared with first-generation techniques (HR 0.69, 95% CI 0.63-0.76). The rate of a subsequent hysterectomy within 5 years was 13.5%. Younger women (OR 0.59, 95% CI 0.51-0.69) and those who had balloon, microwave, or radiofrequency ablation were less likely to have a second EA procedure, rather than a hysterectomy.
  
  
  CONCLUSIONS
  One in six women have further surgery after EA for HMB, which is a higher rate than reported in clinical trials. This risk of further surgery decreases with age.
authors.affiliation: Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists (RCOG), London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bansi-Matharu
authors.forename: I
authors.initials: I
authors.lastname: Gurol-Urganci
authors.forename: T A
authors.initials: TA
authors.lastname: Mahmood
authors.forename: A
authors.initials: A
authors.lastname: Templeton
authors.forename: J H
authors.initials: JH
authors.lastname: van der Meulen
authors.forename: D A
authors.initials: DA
authors.lastname: Cromwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007889:Leiomyoma / Q000150:complications; D008595:Menorrhagia / Q000601:surgery*; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D011127:Polyps / Q000150:complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D002577:Uterine Cervical Diseases / Q000150:complications; D055815:Young Adult
keywords: Endometrial ablation; heavy menstrual bleeding; hysterectomy