The surgical treatment of idiopathic abnormal uterine bleeding: An analysis of 88 000 patients from the French exhaustive national hospital discharge database from 2009 to 2015.

The objective of the study was to compare success rates, complications and management costs of different surgical techniques for abnormal uterine bleeding (AUB). This was a retrospective analysis of the French national hospital discharge database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure code between 2009 and 2015 inclusive were identified, concerning 109,884 women overall. Outcomes were compared between second generation procedures (2G surgery), first-generation procedures (1G surgery), curettage and hysterectomy. Clinical outcomes were treatment failure and complications during the follow-up period. Costs were attributed using standard French hospital tariffs. 7,863 women underwent a 2G procedure (7.2%), 39,935 a 1G procedure, (36.3%), 38,923 curettage (35.4%) and 23,163 hysterectomy (21.1%). Failure rates at 18 months were 9.9% for 2G surgery, 12.7% for 1G surgery, 20.6% for curettage and 2.8% for hysterectomy. Complication rates at 18 months were 1.9% for 2G surgery, 1.5% for 1G surgery, 1.4% for curettage and 5.3% for hysterectomy. Median 18-month costs were € 1 173 for 2G surgery, € 1 059 for 1G surgery, € 782 for curettage and € 3 090 for hysterectomy. Curettage has the highest failure rate. Hysterectomy has the lowest failure rate but the highest complication rate and is also the most expensive. Despite good clinical outcomes and relatively low cost, 1G and 2G procedures are not widely used. Current guidelines for treatment of AUB are not respected, the recommended 2G procedures being only used in <10% of cases.

Déclaration de conflit d'intérêts

JF has received personal fees from HEVA, and discloses collaborations with BMS and Allergan; DT has received personal fees from Hologic; PD declares no conflict of interest; GD has received personal fees for participating in scientific advisory boards from Hologic and for participating in symposia from Hologic and Samsung. HF has received personal fees from Hologic, and discloses collaboration with Hologic, Bayer and Gedeon-Richter, Delmont. In addition to being investigators in trials involving these companies, relationships include consultancy service and membership of scientific advisory boards. LdL, GC, TL and LL have received grants, via their company, from Hologic. The study was funded by Hologic, a company that markets NovaSure®, a radiofrequency endometrial ablation device. This does not alter our adherence to Plos One policies on sharing data and materials.