Hysterectomy Rate Following Endometrial Ablation in Ontario: A Cohort Analysis of 76,446 Patients

Endometrial Ablation (EA) is an alternative to hysterectomy for the management of abnormal uterine bleeding (AUB); however, it does not eliminate the need for future surgical re-intervention. The primary objective of this study was to establish long-term clinical outcomes including the risk of hysterectomy in women who had undergone a primary EA. This is a retrospective population-based cohort study utilising administrative data from the Canadian province of Ontario. This study assesses patients undergoing surgery in a publicly funded health care system. We assessed women in Ontario undergoing a primary EA over a 15-year period. The primary outcome was hysterectomy within 5 years of primary EA. Secondary outcomes included myomectomy and repeat EA. All outcomes were also reported for 1, 3, 5, 10 and 15 years of follow-up. Logistic regression was used to establish predictors of hysterectomy within 5 years of primary EA. A total of 76,446 primary EAs were evaluated from 2002-2017, with 16,480 (21.56%) undergoing a subsequent surgical intervention. The average age of primary EA was 43.8 (+/- 6.3) years. Within 5 years, the evaluable cohort was 52,464, with 8,635 (16.46%) of women having proceeded to hysterectomy, 664 (1.27%) to myomectomy, and 2,468 (2.8%) to repeat ablation. By 15-years follow-up, the evaluable cohort was 1,788, with 28.75% had undergone a hysterectomy, 2.01% a myomectomy, and 5.20% a repeat EA. On logistic regression analysis, advancing age at time of EA was associated with significantly decreased odds of hysterectomy (OR=0.94, 95% CI 0.935-0.944, p