Risk of Hysterectomy Following Endometrial Ablation: A 10-Year Retrospective Analysis

Abstract Purpose This study assessed indication for hysterectomy following failed endometrial ablation and identified risk factors for therapy failure. Methods A retrospective cohort study of 1054 patients undergoing endometrial ablation from January 1, 2011, to January 1, 2021, within the Yale New Haven Health system was conducted using chi-square and ANOVA tests. No interventions were made in this study. Results The hysterectomy rate amongst endometrial ablation patients was 18% (n = 190). Each additional year post ablation decreased the risk of subsequent hysterectomy by 5% (aHR 0.95, p < .05). Patients with BMI of 30-39.9 had a 61% increased risk of subsequent hysterectomy (aHR 1.61, p = .003), and a BMI ≥ 40 had a 108% increased risk (aHR 2.08, p = .002). A history of diabetes showed a nonsignificant trend toward increased risk of hysterectomy (aHR 1.44, p = 0.09). The primary indication for hysterectomy after ablation was persistent AUB (68.9%). The primary uterine pathology identified at time of hysterectomy was leiomyoma (61.1%). Conclusion Endometrial ablation has become a popular choice for treatment of abnormal uterine bleeding given its minimally invasive nature and cost-effectiveness. This study demonstrated 1 in 5 women will require hysterectomy post ablation. Risk factors including younger age, presence of leiomyoma or adenomyosis, and obesity, can increase patient’s risk of requiring hysterectomy for management. There was no significant difference in parity, race-ethnicity, history of hypertension, diabetes, or smoking, within the two cohorts. These findings can be used to enhance patient counseling and selection of appropriate candidates for endometrial ablation.