Lack of Data-driven Treatment Guidelines and Wide Variation in Management of Chronic Pelvic Pain in Adolescents and Young Adults

Hung YC, Ya‐Ching Hung, Ya-Ching Hung, Westfal ML, Maggie L. Westfal, Chang DC, David C. Chang, Kelleher CM, Cassandra M. Kelleher
Journal of Pediatric and Adolescent Gynecology · 2020 · vol. 33(4) , pp. 349–353.e1 · doi:10.1016/j.jpag.2020.03.009 · PMID:32259629 · W3014701523
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This study surveyed clinicians and found a lack of data-driven treatment guidelines and significant variability in managing chronic pelvic pain in adolescent and young adult patients.

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Abstract

STUDY OBJECTIVE: Current literature lacks data-driven guidelines for surgical treatment of adolescent and young adult (AYA) patients with chronic pelvic pain. We hypothesized that there is a significant variation in treatment of these patients, which might be an indicator of over- or undertreatment by some providers. DESIGN AND SETTING: We completed a retrospective population-based analysis of the Nationwide Inpatient Sample from 1998 to 2016. PARTICIPANTS: We included AYA patients aged 9-25 years whose primary diagnosis was adenomyosis, endometriosis, or chronic pelvic pain. Patients who might have undergone pelvic or abdominal procedures for other primary diagnoses were excluded. INTERVENTIONS AND MAIN OUTCOME MEASURES: Trends of inpatient surgical intervention were calculated. Logistic regression was performed to determine the likelihood of undergoing an intervention, adjusted for patient demographic characteristics. RESULTS: A total of 13,111 AYA patients were analyzed. Median age at diagnosis was 22 (interquartile range, 20-24) years. The overall inpatient intervention rate was 5879/13111 (45.0%) (2445/5897 (18.6%) for excision/ablation, 2057/5897 (15.7%) for hysterectomy, 1239/5897 (9.5%) for diagnostic laparoscopy, and 156/5897 (1.2%) for biopsy). Rate of hysterectomy increased in the late 2000s while rates of all other interventions decreased. Patients in the northeast were less likely to undergo an intervention than patients in the rest of the country. Rates of intervention also differed according to race, insurance status, and type of hospital. CONCLUSION: There is wide variation in the use of surgical treatment for chronic pelvic pain in AYA patients across the country and between types of institutions. Of concern, the rate of hysterectomy has increased over time. There is a need for data-directed treatment guidelines for the management of AYA patients with chronic pelvic pain to ensure appropriate application of surgical treatments and expand high-value surgical care.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Pelvic Pain Practice Guidelines as Topic Practice Guidelines as Topic Adolescent Adolescent Adult Adult Chronic Pain Chronic Pain Chronic Pain Female Female Humans Humans Hysterectomy Hysterectomy Hysterectomy Laparoscopy Laparoscopy Laparoscopy

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