Prediction of treatment outcomes after global endometrial ablation

Sherif A. El-Nashar, Matthew R. Hopkins, Douglas J. Creedon, Jennifer St. Sauver, Amy L. Weaver, Michaela E. McGree, William Arthur Cliby, Abimbola O. Famuyide

Research output: Contribution to journalArticle

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Abstract

Objective: To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models. Methods: From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes. Results: The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer. Conclusion: Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling. Level of Evidence: II.

Original languageEnglish (US)
Pages (from-to)97-106
Number of pages10
JournalObstetrics and Gynecology
Volume113
Issue number1
DOIs
StatePublished - Jan 2009

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Endometrial Ablation Techniques
Confidence Intervals
Amenorrhea
Treatment Failure
Odds Ratio
Radio
Hot Temperature
Hemorrhage
Tubal Sterilization
Dysmenorrhea
Pelvic Pain
Endometrial Neoplasms
Parity
Hysterectomy
Proportional Hazards Models

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

El-Nashar, S. A., Hopkins, M. R., Creedon, D. J., St. Sauver, J., Weaver, A. L., McGree, M. E., ... Famuyide, A. O. (2009). Prediction of treatment outcomes after global endometrial ablation. Obstetrics and Gynecology, 113(1), 97-106. https://doi.org/10.1097/AOG.0b013e31818f5a8d

Prediction of treatment outcomes after global endometrial ablation. / El-Nashar, Sherif A.; Hopkins, Matthew R.; Creedon, Douglas J.; St. Sauver, Jennifer; Weaver, Amy L.; McGree, Michaela E.; Cliby, William Arthur; Famuyide, Abimbola O.

In: Obstetrics and Gynecology, Vol. 113, No. 1, 01.2009, p. 97-106.

Research output: Contribution to journalArticle

El-Nashar, SA, Hopkins, MR, Creedon, DJ, St. Sauver, J, Weaver, AL, McGree, ME, Cliby, WA & Famuyide, AO 2009, 'Prediction of treatment outcomes after global endometrial ablation', Obstetrics and Gynecology, vol. 113, no. 1, pp. 97-106. https://doi.org/10.1097/AOG.0b013e31818f5a8d
El-Nashar, Sherif A. ; Hopkins, Matthew R. ; Creedon, Douglas J. ; St. Sauver, Jennifer ; Weaver, Amy L. ; McGree, Michaela E. ; Cliby, William Arthur ; Famuyide, Abimbola O. / Prediction of treatment outcomes after global endometrial ablation. In: Obstetrics and Gynecology. 2009 ; Vol. 113, No. 1. pp. 97-106.
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T1 - Prediction of treatment outcomes after global endometrial ablation

AU - El-Nashar, Sherif A.

AU - Hopkins, Matthew R.

AU - Creedon, Douglas J.

AU - St. Sauver, Jennifer

AU - Weaver, Amy L.

AU - McGree, Michaela E.

AU - Cliby, William Arthur

AU - Famuyide, Abimbola O.

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N2 - Objective: To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models. Methods: From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes. Results: The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer. Conclusion: Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling. Level of Evidence: II.

AB - Objective: To report rates of amenorrhea and treatment failure after global endometrial ablation and to estimate the association between patient factors and these outcomes by developing and validating prediction models. Methods: From January 1998 through December 2005, 816 women underwent global endometrial ablation with either a thermal balloon ablation or radio frequency ablation device; 455 were included in a population-derived cohort (for model development), and 361 were included in a referral-derived cohort (for model validation). Amenorrhea was defined as cessation of bleeding from immediately after ablation through at least 12 months after the procedure. Treatment failure was defined as hysterectomy or reablation for patients with bleeding or pain. Logistic and Cox proportional hazard regression models were used in model development and validation of potential predictors of outcomes. Results: The amenorrhea rate was 23% (95% confidence interval [CI] 19-28%) and the 5-year cumulative failure rate was 16% (95% CI 10-20%). Predictors of amenorrhea were age 45 years or older (adjusted odds ratio [aOR] 2.6, 95% CI 1.6-4.3); uterine length less than 9 cm (aOR 1.8, 95% CI 1.1-3.1); endometrial thickness less than 4 mm (aOR 2.7, 95% CI 1.2-6.3); and use of radio-frequency ablation instead of thermal balloon ablation (aOR 2.8, 95% CI 1.7-4.9). Predictors of treatment failure included age younger than 45 years (adjusted hazard ratio [aHR] 2.6, 95% CI 1.3-5.1); parity of 5 or greater (aHR 6.0, 95% CI 2.5-14.8); prior tubal ligation (aHR 2.2, 95% CI 1.2-4.0); and history of dysmenorrhea (aHR 3.7, 95% CI 1.6-8.5). After global endometrial ablation, 23 women (5.1%, 95% CI 3.2-7.5%) had pelvic pain, three (0.7%, 95% CI 0.1-1.9%) were pregnant, and none (95% CI 0-0.8%) had endometrial cancer. Conclusion: Population-derived rates and predictors of treatment outcomes after global endometrial ablation may help physicians offer optimal preprocedural patient counseling. Level of Evidence: II.

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