Y. Hung1,2, M. L. Westfal1,2,3, D. C. Chang1,2, C. M. Kelleher2,3 1Massachusetts General Hospital,Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3MassGeneral Hospital for Children,Boston, MA, USA
Introduction: Current literature lacks data-driven guidelines for surgical treatments of adolescents and young adults (AYA) with endometriosis. We hypothesized that there is a significant variation in treatment, which may be an indicator of over or under treatment by some providers. The goal of this study is to review trends of different surgical treatments over time and across regions of the United States.
Methods: We completed a retrospective population-based analysis of the Nationwide Inpatient Sample from 1998 to 2011, including AYA patients 9-25 years old with endometriosis or chronic pelvic pain. We excluded patients who may have undergone pelvic or abdominal procedures for other reasons. Trends of diagnostic laparoscopy, biopsy, excision and hysterectomy were calculated. Logistic regression was performed to determine the risk of intervention, adjusting for patient demographics.
Results: A total of 50,464 AYAs were analysed. Median age at diagnosis was 21 (IQR 17-23). Overall intervention rate was 15.9% (3.5% diagnostic laparoscopy, 0.5% for biopsy, 7.6% for excision/ablation, 4.3% for hysterectomy). Rate of hysterectomy increased in the late 2000s while rates of all other interventions decreased (Figure 1). On adjusted analysis, patients with private insurance were more likely to receive interventions than patients with Medicaid (OR 1.3, 95% CI 1.2-1.4). In addition, patients treated in rural and non-teaching hospitals were more likely to undergo interventions than those treated in urban teaching hospitals (OR 1.2 95% CI 1.1-1.3, OR 1.1 95% CI 1.0-1.2, respectively).
Conclusion: There is wide variation in treatment patterns of endometriosis in AYA patients across the country and between types of institutions. Of concern, the rate of hysterectomy has increased over time. There is a need for data-directed treatment guidelines for the management of AYAs with endometriosis to reduce possible unnecessary surgeries and to expand value-based surgical care.?
