Surgical Decision Regret in Women Pursuing Surgery for Endometriosis or Chronic Pelvic Pain

Meenal Misal, Girardo M, Marlene Girardo, Megan N Wasson, Megan Wasson
Journal of Minimally Invasive Gynecology · 2020 · vol. 28(7) , pp. 1343–1350 · doi:10.1016/j.jmig.2020.09.016 · PMID:32979533 · W3087812284
Observational OA: closed CC0 ⤵ 6 in-corpus citations
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This study investigated surgical decision regret in women undergoing procedures for endometriosis or chronic pelvic pain.

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Abstract

STUDY OBJECTIVE: To identify incidence of decision regret associated with surgery for endometriosis or chronic pelvic pain (CPP). DESIGN: Survey study. SETTING: Academic medical center. PATIENTS: All patients undergoing excisional surgery for endometriosis or CPP between January 2016 and June 2019. INTERVENTIONS: The women were contacted to complete 2 validated questionnaires: the Decision Regret and Patient Global Impression of Improvement scales. MEASUREMENTS AND MAIN RESULTS: A total of 253 patients were contacted, and 154 patients responded (60.8% response rate) to the survey. A total of 137 women (90%) agreed or strongly agreed that having excisional surgery was the right decision; 134 women (87%) indicated that they would choose to have surgery again. The survey responders did not differ from nonresponders in age (years, 33.9 vs 35; p = .25), robotic route of surgery (83.1% vs 78.8%; p = .66), or performance of hysterectomy (27.3% vs 26.3%; p = .85). The responders were more likely to have stage III/IV endometriosis (50.6% vs 29.3%; p <.01), more previous surgeries for endometriosis (median surgeries, 1 vs 0; p = .01), higher complication rate (8.4% vs 2.0%; p = .03), and pathology test results more frequently positive for endometriosis (87.7% vs 77.8%; p = .03). Overall, 25 patients (16.3%) reported some level of regret after excisional surgery for endometriosis or CPP. Regret was not associated with a lower Patient Global Impression of Improvement score (odds ratio [OR] 4.37; 95% confidence interval [CI], 0.81-23.7), age (OR 0.98; 95% CI, 0.93-1.04), time since surgery (OR 1; 95% CI, 0.97-1.04), number of previous surgeries (OR 1.08; 95% CI, 0.9-1.31), negative pathology test results (OR 2.82; 95% CI, 0.95-8.32), hysterectomy (OR 1.23; 95% CI, 0.45-3.32), or complications (OR 1.07; 95% CI, 0.22-5.16). CONCLUSION: Most women who pursue excisional surgery for endometriosis or CPP are satisfied with their decision. Regret was not associated with patient-reported lack of improvement, negative pathology test results, hysterectomy, or complications. Gynecologic surgeons should engage in shared decision-making with patients and feel comfortable offering surgical evaluation and management to patients with endometriosis or CPP when clinically indicated.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Chronic Pain Chronic Pain Chronic Pain Chronic Pain Endometriosis Endometriosis Endometriosis Endometriosis Emotions Emotions Female Female Humans Humans Hysterectomy Hysterectomy Hysterectomy Pelvic Pain Pelvic Pain Pelvic Pain

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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