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Prediction of unsuccessful endometrial ablation: a retrospective study

Authors
  • Stevens, K. Y. R.1, 2
  • Meulenbroeks, D.1
  • Houterman, S.3
  • Gijsen, T.4
  • Weyers, S.2
  • Schoot, B. C.1, 2
  • 1 Catharina Hospital, Department of Obstetrics and Gynaecology, Michelangelolaan 2, Eindhoven, EJ, 5623, The Netherlands , Eindhoven (Netherlands)
  • 2 Ghent University Hospital, Women’s Clinic, Corneel Heymanslaan 10, Ghent, 9000, Belgium , Ghent (Belgium)
  • 3 Catharina Hospital, Department of Education and Research, Michelangelolaan 2, Eindhoven, EJ, 5623, The Netherlands , Eindhoven (Netherlands)
  • 4 Elkerliek Hospital, Department of Obstetrics and Gynaecology, Wesselmanlaan 25, Helmond, HA, 5707, The Netherlands , Helmond (Netherlands)
Type
Published Article
Journal
Gynecological Surgery
Publisher
Springer Berlin Heidelberg
Publication Date
May 01, 2019
Volume
16
Issue
1
Identifiers
DOI: 10.1186/s10397-019-1060-1
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundEndometrial ablation (EA) is a frequently used treatment for abnormal uterine bleeding, mainly due to the low risks, low costs and short recovery time associated with the procedure. On the short term, it seems successful, long-term follow-up however, shows decreasing patient satisfaction as well as treament efficacy. There even is a post-ablation hysterectomy rate up to 21%. Multiple factors seem to` influence the outcome of EA. Due to dissimilarities in and variety of these factors, it has not been possible so far to predict the success rate of EA based on pre-operative factors.Therefore, the aim of this study is to develop two prediction models to help counsel patients for failure of EA or necessity of surgical re-intervention within 2 years after EA.MethodsWe designed a retrospective two-centred cohort study in Catharina Hospital, Eindhoven and Elkerliek Hospital, Helmond, both non-university teaching hospitals in the Netherlands. The study population consisted of 446 pre-menopausal women who underwent EA for abnormal uterine bleeding, with a minimum follow-up time of 2 years. Multivariate logistic regression analysis was used to create the prediction models.ResultsThe mean age of the patients was 43.8 years (range 20–55), 97.3% had complaints of menorrhagia, 57.4% of dysmenorrhoea and 61.0% had complaints of intermittent or irregular bleeding. 18.8% of patients still needed a hysterectomy after EA. The risk of re-intervention was significantly greater in women with menstrual duration > 7 days or a previous caesarean section, while pre-operative menorrhagia was significantly associated with success of EA. Younger age, parity ≥ 5 and dysmenorrhea were significant multivariate predictors in both models. These predictors were used to develop prediction models, which had a C-index of 0.71 and 0.68 respectively.ConclusionWe propose two multivariate models to predict the chance of failure and surgical re-intervention within 2 years after EA. Due to the permanent character of EA, the increasing number of post-operative failure and re-interventions, these prediction models could be useful for both the doctor and patient and may contribute to the shared decision-making.

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