Endometriosis: what is the risk of hospital admission, readmission, and major surgical intervention?

Abstract

Study objective: To describe trends in hospital utilization and surgical rates for endometriosis and to estimate the probability of hospital readmission over 4 years among women with early-stage disease.

Design: Population-based, retrospective cross-sectional and longitudinal analysis of 53,385 hospital admissions for same-day surgery or inpatient treatment of endometriosis from fiscal years 1994/95 through 2001/02 (Canadian Task Force classification III).

Setting: All hospital discharge records that listed endometriosis as the most-responsible diagnosis in the province of Ontario, Canada, from fiscal years 1994-1995 through 2001-2002.

Patients: Ontario female patients 15 years of age or older admitted to the hospital for treatment of endometriosis.

Interventions: Surgical treatments were classified as minor, intermediate, or major depending on the extent of the surgery.

Measurements and main results: Age-standardized annual discharge rates were calculated and trends in surgical treatment described. The records of 7993 women who received minor or intermediate surgery on their index hospital visit were linked, and the likelihood and predictors of readmission were calculated using survival analysis and logistic regression. During the observation period, the standardized discharge rates fell significantly from 172.9 per 100,000 women aged 15 to 70 to 137.1 per 100,000 (p<.05). Age-specific rates were highest for women aged 15 to 39 (approximately 200 per 100,000). The proportion of hospitalizations involving minor surgeries dropped (from 27% to 17%), and the proportion involving intermediate surgeries increased (from 40% to 53%). The likelihood of hospital readmission within 4 years for additional surgical treatment was 27% and of having a hysterectomy was 12%.

Conclusion: Fewer women are being hospitalized for minor surgical procedures for endometriosis with hospital-based care being reserved for more extensive procedures. Nonetheless, about a quarter of women hospitalized for initial surgical treatment for endometriosis will undergo additional surgical treatment within 4 years, and one in 10 will have a hysterectomy.