Surgical Decision Regret in Women Pursuing Surgery for Endometriosis or Chronic Pelvic Pain

摘要

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 CPP between January 2016 and June 2019. Interventions: The women were contacted to complete 2 validated questionnaires: the Decision Regret and Patient Global Impression of Improvement scales. Measurements and Main Results: A total of 253 patients were contacted, and 154 patients responded (60.8 response rate) to the survey. A total of 137 women (90) agreed or strongly agreed that having excisional surgery was the right decision; 134 women (87) indicated that they would choose to have surgery again. The survey responders did not differ from nonresponders in age (years, 33.9 vs 35; p = .25), robotic route of surgery (83.1 vs 78.8; p = .66), or performance of hysterectomy (27.3 vs 26.3; p = .85). The responders were more likely to have stage III/IV endometriosis (50.6 vs 29.3; p < .01), more previous surgeries for endometriosis (median surgeries, 1 vs 0; p = .01), higher complication rate (8.4 vs 2.0; p = .03), and pathology test results more frequently positive for endometriosis (87.7 vs 77.8; p = .03). Overall, 25 patients (16.3) reported some level of regret after excisional surgery for endometriosis or CPP. Regret was not associated with a lower Patient Global Impression of Improvement score (odds ratio OR 4.37; 95 confidence interval CI, 0.81-23.7), age (OR 0.98; 95 CI, 0.93-1.04), time since surgery (OR 1; 95 CI, 0.97-1.04), number of previous surgeries (OR 1.08; 95 CI, 0.9-1.31), negative pathology test results (OR 2.82; 95 CI, 0.95-8.32), hysterectomy (OR 1.23; 95 CI, 0.45-3.32), or complications (OR 1.07; 95 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 test results, 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. (C) 2020 AAGL. All rights reserved.