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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Steele A, Love J. Systematic review, meta-analysis and statistical analysis of laparoscopic supracervical hysterectomy vs. endometrial ablation. J Turk Ger Gynecol Assoc 2021; 22:97-106. [PMID: 33663195 PMCID: PMC8187984 DOI: 10.4274/jtgga.galenos.2021.2020.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: This meta-analysis aimed to compare the effect of laparoscopic supracervical hysterectomy (LSH) with endometrial ablation (EA) in terms of general and menstrual-related quality of life in women opting for surgical treatment for abnormal uterine bleeding. Material and Methods: Sources searched included PubMed, Cochrane library, Scopus, and Web of Science for relevant clinical trials. Main outcomes of interest included: quality of life assessed using medical outcomes survey short form-36 (SF-36), (SF-12), operation time, time from operation to discharge, pain, fever, and hemoglobin level. Screening and data extraction were performed independently and the analysis was conducted using Review Manager Software v5.4.1. Results: Four clinical trials were included. Results of SF-12 score showed that there was no significant difference between the LSH and EA groups for either mental or physical component score overall mean difference (MD): -4.15 (-16.01, 7.71; p=0.49) and MD: 2.67 (-0.37, 5.71; p=0.08), respectively. Subgroup analysis of the SF-36 showed that only two components, general health and social function, were significantly improved in the LSH group (p<0.01) while the other six sub-scores did not differ between groups. The overall MD significantly favored the EA group for: operation time [MD: 72.65 (35.48, 109.82; p=0.0001)], time from operation to discharge [MD: 13.61 (3.21, 24.01; p=0.01)], hemoglobin level outcome [MD: 0.57 (0.40, 0.74); p<0.01], and pain score [standardized MD: 0.46 (0.32, 0.60; p<0.01)]. Conclusion: LSH has better outcomes for quality of life. This includes patient indicated responses to social health, general health, and superior hemoglobin levels at all measured points postoperatively. EA, however, was consistently associated with less operative time, a shorter hospital stay and is also considered by the authors to be a more minimally invasive technique which can also result in satisfying outcomes.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Ali Azadi
- Department of Urogynecology, Star Urogynecology Advanced Pelvic Health Institute for Women, Arizona, United States of America
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Ahmed Masoud
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Sophia Hopewell
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Anthony Galitsky
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Allison Steele
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
| | - Jennifer Love
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
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Bonafede MM, Miller JD, Laughlin-Tommaso SK, Lukes AS, Meyer NM, Lenhart GM. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:423-9. [PMID: 25336979 PMCID: PMC4199837 DOI: 10.2147/ceor.s67888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Women with abnormal uterine bleeding (AUB) may be treated surgically with hysterectomy or global endometrial ablation (GEA), an outpatient procedure. We compared the costs and clinical outcomes of these surgical procedures for AUB among women in Medicaid programs. Methods The Truven Health MarketScan® Medicaid Multi-State Database was used to identify Medicaid women aged 30–55 years with AUB who newly initiated GEA or hysterectomy (index event) during 2006–2010. Patients were required to have 12 months of continuous enrollment pre-index and post-index. Baseline characteristics were assessed in the pre-index period; health care utilization and costs (2011 USD), treatment complications, and reinterventions were assessed in the post-index period. Results Of 1,880 women who met the study criteria (mean age 40.7 years), 53.4% were Caucasian, 33.1% were African-American, and 2.3% were Hispanic; many (42.8%) received their Medicaid eligibility due to disability. Similar proportions received GEA (50.9%) or hysterectomy (49.1%). At baseline, both groups also had similar Deyo-Charlson Comorbidity scores (0.65), and use of antibiotics (69.4%), nonsteroidal anti-inflammatory drugs (56.3%), and oral contraceptives (5.3%). More hysterectomy patients than GEA patients had a treatment-related complication (52% versus 36%, respectively, P<0.001). Initial treatment costs were higher for hysterectomy ($11,270) than for GEA ($3,958, P<0.001); monthly gynecology-related costs in the remainder of the year were not significantly different for hysterectomy ($63) and GEA ($16, P=0.11). Conclusion Hysterectomy was nearly three times more costly than GEA for initial treatment of AUB, and associated with more treatment-related complications. These results may be informative in the context of new federal mandates for Medicaid expansion, which are likely to focus on cost savings through use of outpatient treatments such as GEA.
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Affiliation(s)
| | | | | | - Andrea S Lukes
- Women's Wellness Clinic and Research Center, Durham, NC, USA
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Sesti F, Ruggeri V, Pietropolli A, Piancatelli R, Piccione E. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: a randomized study. J Obstet Gynaecol Res 2011; 37:1650-7. [PMID: 21790890 DOI: 10.1111/j.1447-0756.2011.01596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare postoperative outcomes and effects on quality of life following thermal balloon ablation (TBA) or laparoscopic supracervical hysterectomy (LSH) in women with heavy menstrual bleeding (HMB). MATERIAL AND METHODS Sixty-eight women requiring surgical treatment for HMB were randomly allocated into two treatment arms: TBA (n = 34) and LSH (n = 34). The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the effects on menstrual bleeding (Pictorial Blood Loss Assessment Chart [PBAC]) between the two procedures. The secondary outcome measures were quality of life, improvement of bleeding patterns, intensity of postoperative pain, and early postoperative complications. Continuous outcome variables were analyzed using Student's t-test. Discrete variables were analyzed with the χ2 test or Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS The PBAC score was significantly reduced in both treatment groups. After LSH all women had amenorrhea. After TBA there was a significant improvement of bleeding frequency and length. The postoperative pain intensity at 24 h was significantly minor in women treated with TBA rather than with LSH. The Medical Outcomes Survey Short Form 36 (SF-36) score improved in both groups. However, LSH showed a negative impact on the emotional state. No intraoperative complications occurred, and no case was returned to the theatre in either group. CONCLUSION The effectiveness of TBA as a possible treatment of HMB is confirmed. However, LSH showed a definitive improvement of the symptoms, and a better life quality profile. Further controlled prospective studies are required for identifying the best surgical approach in women with HMB.
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Affiliation(s)
- Francesco Sesti
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, School of Medicine, Tor Vergata University Hospital, Rome, Italy.
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Blumenthal PD, Trussell J, Singh RH, Guo A, Borenstein J, Dubois RW, Liu Z. Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception. Contraception 2006; 74:249-58. [PMID: 16904420 DOI: 10.1016/j.contraception.2006.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 02/22/2006] [Accepted: 03/27/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to compare the cost-effectiveness of oral contraceptives (OCs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and surgical management in treating dysfunctional uterine bleeding (DUB) in women not desiring additional children. METHOD A Markov model was constructed from the perspective of the health services payers for a 5-year period. Treatment costs, DUB treatment success rates and contraception success rates were obtained through a literature review. RESULTS In women not responding to an initial trial of OCs, surgical management was more effective than the LNG-IUS (95.5% vs. 92%) but at higher cost (US$4853 vs. US$2796 per woman). Among responders to OCs, continuing treatment with the LNG-IUS instead of OCs was more effective (92% vs. 90.4%) and less expensive (US$2796 vs. US$4711). For women naïve to medical therapy, the LNG-IUS and OCs had similar effectiveness, but cost for the LNG-IUS was lower (US$2796 vs. US$4895). In all scenarios, surgery followed if medical therapy failed; rates of primary method failure were 62.5% with OCs and 34% with the LNG-IUS at 12 months. CONCLUSIONS Treatment strategies employing the LNG-IUS are the most cost-effective in managing DUB, regardless of whether a woman has previously tried OC therapy.
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Affiliation(s)
- Paul D Blumenthal
- Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Phelan JT, Broder J, Kouides PA. Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization. Am J Hematol 2004; 77:151-5. [PMID: 15389826 DOI: 10.1002/ajh.20113] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, epsilon-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/microL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting.
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Affiliation(s)
- John T Phelan
- Lipson Cancer Center and Center for Blood Disorders, Rochester General Hospital, Rochester, New York 14625, USA.
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