Does incidental endometriosis at laparoscopic tubal sterilization increase future health care utilization

David Seil Kim
2005 · W2317061308
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Women diagnosed with incidental endometriosis during laparoscopic tubal sterilization had significantly increased physician visits for pelvic pain and subsequent gynecologic surgeries compared to controls.

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This retrospective cohort study used a large third-party health insurance database from Hawai’i (1999–2003) to compare outcomes in patients who had laparoscopic tubal sterilization with an incidental diagnosis of endometriosis versus those without endometriosis. Over the subsequent 5-year period, the endometriosis group had higher rates of physician office visits for abdominal/pelvic pain (80% higher) and substantially higher rates of subsequent gynecologic surgeries (5.6-fold), along with higher associated office/procedure/prescription costs. There was no observed difference between groups in emergency room/hospital visits or in the number of pain medication prescriptions. The paper’s limitation is that it relies on administrative coding within a single-state insurance database, which may not capture all clinical details. This paper is centrally about endometriosis — specifically whether incidental endometriosis detected during laparoscopic tubal sterilization predicts greater future healthcare utilization.

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Abstract

Objectives: To identify if patients diagnosed with incidental endometriosis at the time of laparoscopic tubal sterilization experience a greater utilization of physician office visits for pelvic pain, gynecological surgeries, and/or pain medications compared to those without endometriosis. Methods: This is a retrospective cohort study utilizing the largest third-party health insurance database in the state of Hawai'i from 1999-2003. Patients with CPT codes consistent with laparoscopic tubal sterilization and an ICO-9 diagnosis code of endometriosis were compared to patients with the laparoscopic tubal sterilization diagnosis but without a diagnosis of endometriosis. Physician office visits for abdominal and pelvic pain, subsequent gynecologic surgeries, and the number of pain medication prescriptions were analyzed between the two groups in the years following tubal sterilization. Results: There were 1219 laparoscopic tubal sterilizations from 1999-2003. Seventy-four (6.07%) of these patients were diagnosed with endometriosis at the time of surgery. In the endometriosis group, there was an 80% (CI 1.06-3.03; p=0.029) higher rate of office visits for abdominal and pelvic pain and 5.6 times (CI=2.95- 10.5; p=0.0001) higher rate of subsequent gynecologic surgeries over the 5 year study period. There was no difference in the rate of emergency room/hospital visits or the number of pain medications prescribed. For office visits, procedures, and prescriptions, there were 78.5%, 95%, and 51 % increases in costs respectively, as compared to the control group. Conclusion: The diagnosis of incidental endometriosis at the time of laparoscopic tubal ligation is associated with a subsequent increase in physician office visits and gynecologic surgeries.
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Does incidental endometriosis at laparoscopic tubal sterilization increase future health care utilization? Loading... Date Authors Contributor Advisor Editor Performer Department Instructor Depositor Speaker Researcher Consultant Interviewer Interviewee Narrator Transcriber Annotator Journal Title Journal ISSN Volume Title Publisher University of Hawaii at Manoa Journal Name Volume Number/Issue Starting Page Ending Page Alternative Title Abstract Objectives: To identify if patients diagnosed with incidental endometriosis at the time of laparoscopic tubal sterilization experience a greater utilization of physician office visits for pelvic pain, gynecological surgeries, and/or pain medications compared to those without endometriosis. Methods: This is a retrospective cohort study utilizing the largest third-party health insurance database in the state of Hawai'i from 1999-2003. Patients with CPT codes consistent with laparoscopic tubal sterilization and an ICO-9 diagnosis code of endometriosis were compared to patients with the laparoscopic tubal sterilization diagnosis but without a diagnosis of endometriosis. Physician office visits for abdominal and pelvic pain, subsequent gynecologic surgeries, and the number of pain medication prescriptions were analyzed between the two groups in the years following tubal sterilization. Results: There were 1219 laparoscopic tubal sterilizations from 1999-2003. Seventy-four (6.07%) of these patients were diagnosed with endometriosis at the time of surgery. In the endometriosis group, there was an 80% (CI 1.06-3.03; p=0.029) higher rate of office visits for abdominal and pelvic pain and 5.6 times (CI=2.95- 10.5; p=0.0001) higher rate of subsequent gynecologic surgeries over the 5 year study period. There was no difference in the rate of emergency room/hospital visits or the number of pain medications prescribed. For office visits, procedures, and prescriptions, there were 78.5%, 95%, and 51 % increases in costs respectively, as compared to the control group. Conclusion: The diagnosis of incidental endometriosis at the time of laparoscopic tubal ligation is associated with a subsequent increase in physician office visits and gynecologic surgeries. Description Citation DOI Extent Format Type Thesis Geographic Location Time Period Related To Theses for the degree of Master of Science (University of Hawaii at Manoa). Biomedical Sciences; no. 4026 Related To (URI) Table of Contents Rights All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner. Rights Holder Catalog Record Local Contexts Collections Email [email protected] if you need this content in ADA-compliant format.

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