13. Pain outcomes in adolescents with surgically confirmed endometriosis: A single-site retrospective cohort analysis

Background

Endometriosis is a leading cause of dysmenorrhea globally, with two thirds of women reporting symptoms beginning in adolescence. Despite increased awareness of adolescent endometriosis, there is a paucity of data regarding best practice for surgical and medical management to improve pain outcomes. This study aims to analyze pain outcomes at one year post index surgery in adolescent patients with surgically diagnosed endometriosis.

Methods

This was a single-site, IRB-approved (STUDY2514), retrospective cohort study reviewing the care of natal females (12-22 years old) with surgically diagnosed endometriosis from 2009 to 2021. Baseline characteristics (demographics and preoperative clinical characteristics) were gathered from chart review. Surgery was classified as diagnostic laparoscopy only, versus ablation and/or excisional biopsy based on the surgeon's operative report. Subset analysis of post-op hormonal management with an intrauterine device (IUD) or leuprolide was performed. Changes in pain status (defined as resolved, improved, same, or worse) were gathered from the subjective documentation within gynecology appointment notes one year post-op. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher's Exact tests. Statistical significance was defined as p< 0.05.

Results

53 patients were identified in this study period. Mean age at time of index surgery was 15 (SD 1.7) years old, and the majority had stage 1 endometriosis. 66% of patients reported their pain was improved one year after their index surgery. There was no significant difference in pain outcome at one year based on whether a patient had a diagnostic surgery only compared to ablation and/or excisional biopsy of endometriosis lesions (p=0.43). There was no significant difference in pain based on the type of hormonal regimen implemented after the index surgery, including those who had an IUD (p=0.76) or received a post-operative course of leuprolide (p=0.7). There was no statistically significant difference in pain outcomes regarding patient demographics, including age (p=0.34) and BMI (p=0.36). Regarding pre-operative clinical characteristics, patients who reported worse pain had seen one additional specialist prior to diagnosis (p=0.005).

Conclusions

Over two thirds of patients who underwent surgical management of endometriosis reported their pain had improved one year following surgery. Patients who had worsening pain, had seen more specialists prior to their index surgery. There was no difference in pain outcomes based on the type of surgical or hormonal intervention, or other baseline patient characteristics.