Faculty Opinions recommendation of Surgical decision regret in women pursuing surgery for endometriosis or chronic pelvic pain.

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 chronic pelvic pain between January 2016 and June 2019 INTERVENTIONS: Women were contacted to complete two validated questionnaires: the decision regret scale (DRS) and the patient global impression of improvement (PGI-I) MEASUREMENTS AND MAIN RESULTS: 253 patients were contacted and 154 patients responded (60.8% response rate) to the survey. 137 women (90%) agreed or strongly agreed that having excisional surgery was the right decision. 134 women (87%) indicated they would choose to have surgery again. Survey responders did not differ from non-responders in age (years, 33.9 vs 35, p = 0.25), robotic route of surgery (83.1% vs. 78.8%, p = 0.66), or performance of hysterectomy (27.3% vs. 26.3%, p = 0.85). Responders were more likely to have stage III/IV endometriosis (50.6% vs. 29.3% p< 0.01), more previous surgeries for endometriosis (median surgeries, 1 vs. 0, p = 0.01), higher complication rate (8.4% vs. 2.0%, p = 0.03), and pathology more frequently positive for endometriosis (87.7% vs. 77.8%, p = 0.03). Overall, 25 patients (16.3%) reported some level of regret after excisional surgery for endometriosis or CPP. Regret was not associated with lower PGI-I score (OR: 4.37, CI: 0.81-23.7), age (OR: 0.98, CI 0.93-1.04), time since surgery (OR: 1, CI: 0.97-1.04), number of previous surgeries (OR: 1.08, CI: 0.9-1.31), negative pathology (OR 2.82, CI: 0.95-8.32), hysterectomy (OR: 1.23, CI: 0.45-3.32), or complications (OR: 1.07, 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, 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.Copyright © 2020. Published by Elsevier Inc. PMID: 32979533