Association between CALLY index and postoperative visceral pain in endometriosis: a retrospective analysis

Belgin Savran Üçok, Türkan Dikici Aktaş, Emel Ozalp, Özgür Volkan Akbulut, Kubilay Çanga
In: Journal of Medicine and Palliative Care · 2026 · vol. 7(2) , pp. 192–197 · doi:10.47582/jompac.1841459 · W7141842605
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This retrospective study found that the CALLY index was associated with both preoperative and postoperative visceral pain in endometriosis patients, and identified it as a predictor of postoperative pain.

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This retrospective comparative study evaluated women aged 18–45 who underwent surgery for stage III–IV endometriosis at Ankara Etlik City Hospital (2022–2024), alongside healthy control women undergoing bilateral tubal ligation, assessing preoperative and postoperative (day 7±1) visceral pain using VAS and calculating the C-reactive protein–albumin–lymphocyte (CALLY) index from blood samples. The authors found that both preoperative and postoperative VAS scores were significantly higher in the endometriosis group than controls, and that postoperative CALLY index values decreased relative to preoperative levels. A weak but statistically significant negative correlation was observed between postoperative CALLY index and VAS scores (ρ = –0.214, p = 0.038), and multivariate linear regression (adjusting for surgical type) identified bilateral endometrioma as the only independent predictor of postoperative visceral pain. This paper is centrally about endometriosis — it links systemic inflammatory-nutritional status (CALLY index) and postoperative visceral pain, highlighting bilateral endometrioma as a key pain predictor.

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Abstract

Aims: To investigate the relationship between preoperative and postoperative visceral pain scores and the C-reactive protein albumin–lymphocyte (CALLY) index in patients with endometriosis and to identify predictors of postoperative pain. Methods: This retrospective comparative study included women aged 18–45 years who underwent surgical treatment for stage III–IV endometriosis at Ankara Etlik City Hospital between 2022 and 2024, with postoperative histopathological confirmation of the diagnosis. The control group consisted of healthy women without pelvic pathology who underwent bilateral tubal ligation for sterilization at the same institution during the study period. Preoperative and postoperative (day 7±1) blood samples were analyzed for CRP, albumin, and lymphocytes to calculate the CALLY index. Visceral pain was evaluated using a Visual Analogue Scale (VAS). Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative pain after adjusting for surgical type (laparotomy/laparoscopy). Results: Ninety-four endometriosis patients and 120 controls were analyzed. Preoperative and postoperative VAS scores were significantly higher in the endometriosis group than controls (p
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Abstract

Amaç: Bu çalışmanın amacı, endometriozisli hastalarda preoperatif ve postoperatif visseral ağrı skorları ile C-reaktif protein–albümin–lenfosit (CALLY) indeksi arasındaki ilişkiyi araştırmak ve postoperatif ağrının prediktörlerini belirlemektir. Yöntemler: Bu retrospektif karşılaştırmalı çalışmaya, 2022–2024 yılları arasında Ankara Etlik Şehir Hastanesi’nde evre III–IV endometriozis nedeniyle cerrahi tedavi uygulanmış, 18–45 yaş arası kadın hastalar dahil edilmiştir. Tanı için histopatolojik doğrulama şartı aranmıştır. Preoperatif ve postoperatif (7. gün ± 1) dönemde alınan kan örneklerinde C-reaktif protein (CRP), albümin ve lenfosit düzeyleri ölçülerek CALLY indeksi hesaplanmıştır. Visseral ağrı, Görsel Analog Skala (VAS) kullanılarak değerlendirilmiştir. Cerrahi yaklaşım (laparotomi/laparoskopi) için düzeltme yapılarak postoperatif ağrının prediktörlerini belirlemek amacıyla tek değişkenli ve çok değişkenli doğrusal regresyon analizleri uygulanmıştır. Bulgular: Toplam 94 endometriozis hastası ve 120 kontrol olgusu analiz edilmiştir. Preoperatif ve postoperatif VAS skorları, endometriozis grubunda kontrol grubuna kıyasla anlamlı olarak daha yüksek bulunmuştur (p < 0.001). Endometriozisli hastalarda postoperatif CALLY indeksi değerleri, preoperatif düzeylere kıyasla anlamlı şekilde azalmıştır (p < 0.001). Ayrıca postoperatif CALLY indeksi ile VAS skorları arasında zayıf ancak istatistiksel olarak anlamlı negatif bir korelasyon saptanmıştır (ρ = –0.214, p = 0.038). Çok değişkenli regresyon analizinde, bilateral endometrioma varlığı postoperatif visseral ağrının tek bağımsız prediktörü olarak belirlenmiştir (düzeltilmiş β = 1.311, p < 0.001). Sonuç: Postoperatif dönemde CALLY indeksi ile ağrı arasında zayıf ancak anlamlı bir ilişki saptanması, sistemik inflamasyonun endometriozisle ilişkili ağrıyı tek başına açıklamakta yetersiz olduğunu göstermektedir. Bilateral endometrioma, kalıcı postoperatif ağrı açısından yüksek riskli bir fenotipi temsil etmektedir. Anatomik hastalık yükünün, inflamatuvar-nutrisyonel indekslerin ve ağrı fenotipinin birlikte değerlendirilmesi, bireyselleştirilmiş ağrı yönetim stratejilerinin geliştirilmesine katkı sağlayabilir.

Keywords

Ethical Statement Çalışma protokolü, kurumsal etik kurul tarafından onaylanmış (Protokol No: AEŞH-BADEK1-2025-262) olup, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Association between CALLY index and postoperative visceral pain in endometriosis: a retrospective analysis

Abstract

Aims: To investigate the relationship between preoperative and postoperative visceral pain scores and the C-reactive protein albumin–lymphocyte (CALLY) index in patients with endometriosis and to identify predictors of postoperative pain.

Methods

This retrospective comparative study included women aged 18–45 years who underwent surgical treatment for stage III–IV endometriosis at Ankara Etlik City Hospital between 2022 and 2024, with postoperative histopathological confirmation of the diagnosis. The control group consisted of healthy women without pelvic pathology who underwent bilateral tubal ligation for sterilization at the same institution during the study period. Preoperative and postoperative (day 7±1) blood samples were analyzed for CRP, albumin, and lymphocytes to calculate the CALLY index. Visceral pain was evaluated using a Visual Analogue Scale (VAS). Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative pain after adjusting for surgical type (laparotomy/laparoscopy).

Results

Ninety-four endometriosis patients and 120 controls were analyzed. Preoperative and postoperative VAS scores were significantly higher in the endometriosis group than controls (p<0.001). In endometriosis patients, postoperative CALLY index values decreased significantly compared to preoperative levels (p<0.001), and a weak but significant negative correlation was found between postoperative CALLY and VAS scores (ρ=–0.214, p=0.038). Multivariate regression identified bilateral endometrioma as the only independent predictor of postoperative visceral pain (adjusted β=1.311, p<0.001).

Conclusion

CALLY index and pain were weakly but significantly correlated postoperatively, indicating that systemic inflammation alone cannot explain endometriosis-related pain. Bilateral endometrioma represents a high-risk phenotype for persistent postoperative pain. Evaluating anatomic burden, inflammatory-nutritional indices, and pain phenotype together may improve individualized pain management strategies.

Keywords

Ethical Statement The study protocol was approved by the institutional ethics committee (Protocol No. AEŞH-BADEK1-2025-262) and performed in accordance with the principles of the Declaration of Helsinki.

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Outcome instruments

VAS-pain

Condition tags

endometriosis

Citation neighborhood

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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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