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

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.