[Analysis from the French DRG-based information system (PMSI) of conservative surgical treatment for abnormal uterine bleeding in 2008-2010]

H. Fernandez, Vincent Villefranque, V Villefranque, P. Panel
Journal de gynecologie, obstetrique et biologie de la reproduction · 2015 · vol. 44(5) , pp. 411–418 · doi:10.1016/j.jgyn.2015.01.009 · PMID:25721347 · W35467345
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This analysis of French hospital data from 2008 to 2010 found that while second-generation endometrial ablation techniques reduced the likelihood of subsequent hysterectomy compared to first-generation methods, most patients still received first-generation treatments.

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Abstract

OBJECTIVE: To evaluate the conservative surgical treatment for abnormal uterine bleeding from the Medicalized Information System Program (PMSI). MATERIALS AND METHODS: The diagnosis codes were selected from 10th version of the international classification disease. A transversal and longitudinal descriptive analysis was performed from hospital stays, patient's characteristics, medical procedures between 2008-2010. RESULTS: Nineteen thousand six hundred and seventy-nine patients were admitted in hospital (public or private) for treatment of abnormal uterine bleeding. Endometrial ablation increased by 16,7%, 10.2% for first generation technique (G1) and 63.5% for second generation techniques (G2). G2 were used in 15% of indications. The median age was respectively 45.2±6.4 years old versus 45.8±4.9 years old for G2. The median length of hospital stay was 1.6 ±1with 69% of patients in ambulatory care. The likelihood to have a hysterectomy in the 3 years follow-up was higher after G1 than G2 treatments (P=0.0034) for the patients above 40 years old. In longitudinal study, defined only by endometrial hyperplasia, 11,532 patients were included and only 8.2% had been treated by G2. CONCLUSION: In spite of the international guidelines since 2008, 85% of patients treated with first generation surgical technique. The failure rate defined by a re-ablation or a hysterectomy is higher after G1. This result must be discussed in relationship with cost effective aspects.

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MeSH descriptors

Gynecologic Surgical Procedures Gynecologic Surgical Procedures Medical Records Systems, Computerized Organ Sparing Treatments Uterine Hemorrhage Adult Endometrial Ablation Techniques Endometrial Ablation Techniques Female France France Gynecologic Surgical Procedures Hospitalization Hospitalization Humans Hysterectomy Hysterectomy Longitudinal Studies Medical Records Systems, Computerized Middle Aged

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