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.

中文翻译：

---

缺乏以数据为依据的治疗指南，且青少年和年轻人的慢性盆腔痛的管理差异很大。

研究目标

当前的文献缺乏以数据为依据的指南，用于治疗患有慢性盆腔痛的青少年（AYA）患者。我们假设这些患者的治疗存在显着差异，这可能表明某些医疗服务提供者过度或治疗不足。

设计与设定

我们从1998年至2016年完成了全国住院患者样本的基于人群的回顾性分析。

参加者

我们纳入了9-25岁的AYA患者，其主要诊断是子宫腺肌病，子宫内膜异位或慢性骨盆痛。排除可能因其他初步诊断而接受了骨盆或腹部手术的患者。

干预措施和主要结果

计算住院手术干预的趋势。进行逻辑回归分析以确定接受干预的可能性，并根据患者的人口统计学特征进行调整。

结果

共分析了13,111名AYA患者。诊断时的中位年龄为22岁（四分位间距为20-24岁）。总体住院干预率为：切除/消融为5879/13111（45.0％）（2445/5897（18.6％），子宫切除术为2057/5897（15.7％），腹腔镜诊断为1239/5897（9.5％），156 / 5897（1.2％）用于活检）。子宫切除术的发生率在2000年代后期有所增加，而其他所有干预措施的发生率均下降了。与该国其他地区的患者相比，东北地区的患者接受干预的可能性较小。干预率也因种族，保险状况和医院类型而异。

结论

在全国和不同类型的机构中，对于AYA患者的慢性骨盆痛，手术治疗的使用存在很大差异。值得关注的是，子宫切除率随着时间的推移而增加。需要有数据导向的治疗指南来管理AYA慢性盆腔痛患者，以确保适当应用手术治疗并扩大高价值的手术治疗。