Age-dependent variations in clinical features and operative time for endometriotic cysts

Endometriosis with ovarian cysts is common in reproductive-age women and contributes to pain and infertility. The influence of age on clinical and surgical outcomes remains uncertain. This retrospective study analyzed 994 patients diagnosed with endometriotic cysts between January 2022 and December 2023 at The Third Affiliated Hospital of Sun Yat-sen University. Patients were stratified into ≤ 30 years (n = 496) and > 30 years (n = 498) groups. Baseline characteristics, comorbidities, ultrasound findings, and surgical outcomes were compared. Patients > 30 years had higher BMI, more frequent uterine fibroids, adenomyosis, and endometrial polyps, larger cyst diameters, and a higher rate of negative sliding signs. Operative time was longer, and concomitant procedures were more frequent. Multivariate logistic regression identified age > 30 years as an independent risk factor for operative time > 150 min (OR = 3.76, p < 0.001), and Cox regression confirmed the significant association (HR = 0.41, p < 0.001). The ASRM score demonstrated limited predictive value (p = 0.155). Age may represent an important factor influencing surgical complexity in endometriotic cysts. In patients over 30 years, more comprehensive preoperative imaging and multidisciplinary evaluation could be considered to optimize perioperative management.