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

¹ Public Health and Policy Research Unit, Barts and the London, Queen Mary’s School of Medicine and Dentistry, University of London, London, UK
² Department of Social Medicine, University of Bristol, Bristol, UK
³ Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
⁴ Newcastle under Lyme PCT and University of Keele, Stoke on Trent, Staffordshire, UK
⁵ St Mary’s Hospital for Women and Children, Manchester, UK
⁶ Withybush Hospital, Haverfordwest, Pembrokeshire, UK
⁷ Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to:
Dr A Clarke
Public Health and Policy Research Unit, Institute of Community Health Sciences, Medical Sciences Building, Queen Mary, University of London, London E1 4NS, UK; a.e.clarke{at}qmul.ac.uk 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.

Keywords: readmission; hysterectomy; endometrial resection