Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study

Abstract

Objectives: To investigate the readmission experience of a large national prospective cohort of women up to 5 years after undergoing either transcervical resection of the endometrium (TCRE) or hysterectomy to assess reasons for readmission and whether TCRE can be viewed as a definitive substitute for hysterectomy. Design and participants: Data are from the VALUE/MISTLETOE prospective national cohort studies of hysterectomy and TCRE respectively. 5294 women who underwent hysterectomy for dysfunctional uterine bleeding in 1994/5 and 4032 women who underwent TCRE in 1993/4 and who responded to postal questionnaires were included. Surgeons gathered operative details. Women completed postal follow up questionnaires at 3 and 5 years after surgery asking about readmission to hospital and reasons for readmission. Adjusted proportional hazard ratios were calculated for likelihood of readmission in each category comparing types of surgery. Results: 41.7% of women undergoing hysterectomy and 44.6% of women undergoing TCRE experienced one or more readmissions to hospital overall within 5 years (adjusted hazard ratio for all readmissions (AHR) 0.87 (95% confidence interval (CI) 0.80 to 0.95)). 12.6% of hysterectomy patients and 30.3% of TCRE patients were readmitted for gynaecological reasons (AHR 0.40 (95% CI 0.33 to 0.48)). Rates of readmission for gynaecological reasons were similar up to 6 months but were markedly reduced for hysterectomy compared with TCRE patients towards the end of the follow up period (AHR for readmission at 3-5 years 0.28 (95% CI 0.20 to 0.39)). Conclusions: There are differences in the pattern of readmission to hospital after hysterectomy and TCRE for dysfunctional uterine bleeding. Women undergoing a hysterectomy are less likely to be readmitted to hospital up to 5 years after their operation overall, and are significantly less likely to be readmitted for reasons related to their operation, particularly for gynaecological reasons. Hysterectomy appears to be a more definitive operation. The different options for surgery for dysfunctional uterine bleeding are not interchangeable; they represent different patterns of care. Information should be available to women and practitioners to inform choices between these options. R eadmission to hospital has been seen as a potential measure of outcome of care. It is attractive because it can be gleaned relatively easily from administrative databases and because it has an intuitive appeal. 1 We were interested in investigating readmission to hospital for women undergoing two different interventions for benign cause menorrhagia or dysfunctional uterine bleeding. Readmission to hospital, especially for operation related reasons, is likely to be distressing and may indicate a lack of definitive intervention in the index (first) admission. We wanted to compare readmission as a measure of outcome and quality for women undergoing either hysterectomy or transcervical resection of the endometrium (TCRE) to assess whether the newer operation (TCRE) can be seen as a def...

Psychosexual health 5 years after hysterectomy: population‐based comparison with endometrial ablation for dysfunctional uterine bleeding

“…These data show that women are less likely to be readmitted to hospital after hysterectomy, but overall the effects on the symptoms of heavy bleeding are comparable. 6 Hysterectomy for DUB has many effects, both intended and incidental. Lesser surgery like TCRE may have fewer effects, as fewer organs are removed.…”

Re-audit: transcervical resection of the endometrium for heavy menstrual bleeding and the treatment of post-resection uterine stenosis and haematometra by cervical dilatation and the insertion of a levonorgestrel-releasing intra-uterine system

“…Finally, a case may be made for endometrial ablation techniques against hysterectomy, but it is ironic that each woman's case should be assessed on its own merits and it has to be realised that the different options for surgery for dysfunctional uterine bleeding are not interchangeable and they represent different patterns of care [15].…”

Removing organs "just in case"--is prophylactic removal of the ovaries a good thing?

“…25 And a proportion of women undergoing less invasive interventions go on to have hysterectomy subsequently. 26 It may not therefore be possible, or prudent, just to wait until hysterectomy and with it the practice of prophylactic oophorectomy dies a natural death.…”