Hung Ya-Ching, Westfal Maggie L, Chang David C, Kelleher Cassandra M
Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
J Pediatr Adolesc Gynecol. 2020 Aug;33(4):349-353.e1. doi: 10.1016/j.jpag.2020.03.009. Epub 2020 Apr 4.
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.
We completed a retrospective population-based analysis of the Nationwide Inpatient Sample from 1998 to 2016.
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.
Trends of inpatient surgical intervention were calculated. Logistic regression was performed to determine the likelihood of undergoing an intervention, adjusted for patient demographic characteristics.
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.
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.
当前文献缺乏针对青少年及年轻成人（AYA）慢性盆腔痛患者手术治疗的数据驱动指南。我们推测这些患者的治疗存在显著差异，这可能表明一些医疗服务提供者存在过度治疗或治疗不足的情况。
我们对1998年至2016年的全国住院患者样本进行了基于人群的回顾性分析。
我们纳入了9至25岁的AYA患者，其主要诊断为子宫腺肌病、子宫内膜异位症或慢性盆腔痛。排除了因其他主要诊断可能接受盆腔或腹部手术的患者。
计算住院手术干预的趋势。进行逻辑回归以确定接受干预的可能性，并根据患者人口统计学特征进行调整。
共分析了13111例AYA患者。诊断时的中位年龄为22岁（四分位间距，20 - 24岁）。总体住院干预率为5879/13111（45.0%）（切除/消融术为2445/5897（18.6%），子宫切除术为2057/5897（15.7%），诊断性腹腔镜检查为1239/5897（9.5%），活检为156/5897（1.2%））。21世纪后期子宫切除术的比例增加，而所有其他干预措施的比例下降。东北部的患者比该国其他地区的患者接受干预的可能性更小。干预率也因种族、保险状况和医院类型而异。
全国范围内以及不同类型机构之间，AYA慢性盆腔痛患者手术治疗的使用存在很大差异。令人担忧的是，子宫切除术的比例随时间增加。需要针对AYA慢性盆腔痛患者管理的数据导向治疗指南，以确保手术治疗的适当应用，并扩大高价值的手术护理。
