Health Care Utilization and Clinical Outcomes in Patients With Endometriosis and/or Concurrent Pelvic Pain: A Retrospective Analysis of Emergency Department Encounters

INTRODUCTION: While it is well known that endometriosis places a significant burden on both patients and our healthcare system, there remains a poor understanding of how the clinical variability of endometriosis impacts this burden. Patients with endometriosis can present with a wide range of symptoms and there is a need for a more in-depth understanding of how the presence or absence of specific symptoms affects the healthcare utilization and clinical outcomes of these patients. OBJECTIVE: To describe the healthcare utilization of patients presenting to the emergency room with a chief complaint of either endometriosis or endometriosis and concurrent pelvic pain. METHODS: Retrospective review of all unique patient encounters with a chief complaint of endometriosis or pelvic pain at an urban academic institution. Patient encounters were classified as either presenting to the emergency department and discharged (ED), remaining hospitalized (inpatient), or discharged within 24 hours (outpatient). Additional data recorded includes: patient demographics, length of stay, readmission rates, and surgical procedures. RESULTS: Between January 1, 2000, and May 1, 2023, there were 15,299 patients with 35,567 encounters for endometriosis (EM) or pelvic pain (R10): 1,263 (8.25%) had a diagnosis of EM only, 821 (5.37%) had both EM and R10, and 13,215 (86.38%) had R10 only. The EM+R10 group had a higher average number of visits (6.1 vs. 2.2 per patient) compared to the endometriosis-only group, with the greatest difference seen in outpatient visits (5.48 vs. 2.18 per patient). Inpatient visits (1.17 vs. 1.05 visit per patient) and ED visits (1.71 vs. 1.24 visits per patient) were similar between the groups. The average cost per visit was marginally higher for the EM+R10 group at $10,848.02, compared to $9,877.16 for the endometriosis-only group. This cost difference was primarily driven by higher average inpatient costs ($31,374.60 vs. $18,125.16 per visit), despite a similar average length of stay (53.75 hours per visit for the EM-only group vs. 46.51 hours per visit for the EM+R10 group). Conversely, the EM+R10 group had lower average costs for both ED visits ($7,822.83 vs. $9,483.28) and outpatient visits ($6,955.30 vs. $10,636.53). The EM+R10 group had a higher rate of procedures during their visit, averaging 0.45 procedures per patient, compared to 0.29 procedures per patient in the EM group, making EM+R10 patients 1.54 times more likely to undergo a procedure. The EM+R10 group also had notably more laparoscopic adnexal surgeries (225 vs. 181), while the number of hysterectomies (97 vs. 112) and hysteroscopies (41 vs. 58) were more similar. Finally, the EM+R10 group was 3.6 times more likely to experience an emergency readmission (4.26% vs 1.19%) than the EM-only cohort. CONCLUSIONS: The EM+R10 group (patients coded with both EM and R10) are high utilizers of the healthcare system. They had more visits on average compared to the endometriosis-only group, particularly when the ED stay was converted to an outpatient observation. The average cost per visit was higher, primarily due to notably higher inpatient costs. EM+R10 patients were 1.54 times more likely to undergo procedures, especially laparoscopic adnexal surgeries. They were 3.6 times more likely to experience emergency readmissions.