Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.
Reprod Fertil. 2023 Jun 16;4(2). doi: 10.1530/RAF-23-0004. Print 2023 Apr 1.
Patients with chronic pelvic pain (CPP) may experience pain exacerbations requiring hospital admissions. Due to the effects of backlogged elective surgeries and outpatient gynaecology appointments resulting from the COVID-19 pandemic, we hypothesised that there would be an increased number of women admitted with CPP flares. We conducted a retrospective review of all acute gynaecology admissions at the Royal Infirmary of Edinburgh from July to December 2018 (pre-COVID) and 2021 (post-COVID lockdown). We collected information on the proportion of emergency admissions due to CPP, inpatient investigations and subsequent management. Average total indicative hospital inpatient costs for women with CPP were calculated using NHS National Cost Collection data guidance. There was no significant difference in the number of emergency admissions due to pelvic pain before (153/507) and after (160/461) the COVID-19 pandemic. As high as 33 and 31% had a background history of CPP, respectively. Across both timepoints, investigations in women with CPP had low diagnostic yield: <25% had abnormal imaging findings and 0% had positive vaginal swab cultures. Women with CPP received significantly more inpatient morphine, pain team reviews and were more likely to be discharged with strong opioids. Total yearly inpatient costs were £170,104 and £179,156 in 2018 and 2021, respectively. Overall, emergency admission rates for managing CPP flares was similar before and after the COVID-19 pandemic. Inpatient resource use for women with CPP remains high, investigations have low diagnostic yield and frequent instigation of opiates on discharge may risk dependence. Improved community care of CPP is needed to reduce emergency gynaecology resource utilisation.
Existing treatments for chronic pelvic pain (CPP) and endometriosis focus on surgery or hormone medication, but these are often ineffective or associated with unacceptable side-effects. As a result, women continue to experience chronic pain and often have 'flares' of worsening pain that may lead to hospital admission. The COVID-19 pandemic resulted in backlogged gynaecology clinics and surgeries. The aim of this study was to compare the management of emergency pelvic pain admissions for women with CPP before and after COVID-19. We also aimed to better understand their in-hospital management and estimate their hospital length of stay costs. We did not find an increase in CPP patients admitted for pelvic pain flares after the COVID-19 lockdown. Women with CPP often undergo multiple hospital tests and are often prescribed with strong pain medications which can cause long-term problems. Efforts are needed to improve long-term pain management for women with CPP.
慢性盆腔痛（CPP）患者可能会经历疼痛加剧，需要住院治疗。由于 COVID-19 大流行导致积压的择期手术和门诊妇科预约，我们假设因 CPP 发作而住院的女性人数会增加。我们对 2018 年 7 月至 12 月（COVID-19 之前）和 2021 年（COVID-19 封锁之后）爱丁堡皇家医院所有急性妇科入院患者进行了回顾性研究。我们收集了因 CPP 发作而紧急入院的患者比例、住院检查和后续管理的信息。使用 NHS 国家成本收集数据指南计算了 CPP 女性的平均总指示性住院患者费用。COVID-19 大流行前后，因盆腔疼痛而紧急入院的人数没有显著差异（分别为 153/507 和 160/461）。分别有高达 33%和 31%的患者有 CPP 病史。在这两个时间点，CPP 患者的检查结果均无明显诊断价值：<25%的患者有异常影像学发现，0%的患者阴道拭子培养阳性。CPP 女性接受了更多的住院吗啡治疗、疼痛团队评估，更有可能出院时使用强阿片类药物。2018 年和 2021 年的 CPP 女性的总住院年度费用分别为 170,104 英镑和 179,156 英镑。总体而言，COVID-19 大流行前后管理 CPP 发作的紧急入院率相似。CPP 女性的住院资源使用率仍然很高，检查的诊断率较低，出院时经常使用阿片类药物可能会导致依赖。需要改善 CPP 的社区护理，以减少对妇科急症资源的利用。
患有慢性盆腔疼痛（CPP）的患者可能会经历需要住院治疗的疼痛加剧。由于 COVID-19 大流行导致积压的选择性手术和门诊妇科预约，我们假设 CPP 发作导致的女性住院人数会增加。我们对 2018 年 7 月至 12 月（COVID-19 之前）和 2021 年（COVID-19 封锁之后）爱丁堡皇家医院所有急性妇科入院患者进行了回顾性研究。我们收集了因 CPP 发作而紧急入院的患者比例、住院检查和后续管理的信息。使用 NHS 国家成本收集数据指南计算了 CPP 女性的平均总指示性住院患者费用。COVID-19 大流行前后，因盆腔疼痛而紧急入院的人数没有显著差异（分别为 153/507 和 160/461）。分别有高达 33%和 31%的患者有 CPP 病史。在这两个时间点，CPP 患者的检查结果均无明显诊断价值：<25%的患者有异常影像学发现，0%的患者阴道拭子培养阳性。CPP 女性接受了更多的住院吗啡治疗、疼痛团队评估，更有可能出院时使用强阿片类药物。2018 年和 2021 年的 CPP 女性的总住院年度费用分别为 170,104 英镑和 179,156 英镑。总体而言，COVID-19 大流行前后管理 CPP 发作的紧急入院率相似。CPP 女性的住院资源使用率仍然很高，检查的诊断率较低，出院时经常使用阿片类药物可能会导致依赖。需要改善 CPP 的社区护理，以减少对妇科急症资源的利用。
