Treatment Failure Rates of Second-Generation Endometrial Ablation Devices in Premenopausal Women with BMI≥35 Kg/m2

Abstract

<h3>Study Objective</h3> To investigate the treatment failure rates of second-generation endometrial ablation (EA) devices in obese women with BMI≥35 kg/m² in a multi-site single health care system. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Academic community health care system. <h3>Patients or Participants</h3> Premenopausal women aged 18-51 years old who underwent second-generation endometrial ablation for benign indications. <h3>Interventions</h3> Women underwent Radiofrequency Ablation (RFA), Hydrothermal Ablation, Uterine Balloon Ablation, or Combined Argon/RFA Ablation between January 2010 to December 2020. <h3>Measurements and Main Results</h3> 1328 women were identified who underwent second-generation EA of which 1198 patients met criteria. Failure was defined as re-intervention via repeat EA or hysterectomy for persistent uterine bleeding. The overall EA failure rate was 13.9%, with a total of 167 women who required a re-intervention. The proportion of women with BMI<35 kg/m² vs BMI≥35 kg/m² who had a re-intervention was 12.3% vs 17.6% (p=0.019), with an odds ratio of 1.520 (95% CI: 1.083-2.132). Common preoperative diagnoses for re-intervention were abnormal uterine bleeding (73.7%), pelvic pain (50.3%), and fibroid (29.9%). Significant findings on pathology reports after re-intervention showed adenomyosis (44.9%) and fibroids (40.7%). The median time lapse between initial EA and re-intervention was 477 days. <h3>Conclusion</h3> Obesity (BMI≥35 kg/m²) is a risk factor for failure of an endometrial ablation procedure. These findings may be helpful in determining appropriate candidates for this treatment option, as well as improving counseling on possible failure and subsequent risk of re-intervention after an endometrial ablation.