More ED visits, imaging tests, hysterectomies with vs. without chronic pelvic pain

Key takeaways:

• Health care utilization was higher for women with vs. without chronic pelvic pain.
• Women with vs. without chronic pelvic pain had more diagnostic testing, hysterectomies and overlapping pain conditions.

Women with chronic pelvic pain have more ED visits, imaging tests and hysterectomies and higher rates of overlapping chronic pain conditions vs. women without chronic pelvic pain, according to findings published in Obstetrics & Gynecology.

“Patients with chronic pain, including chronic pelvic pain, have higher rates of health care utilization compared to a matched patient cohort,” Isabel Green, MD, MEHP, consultant in minimally invasive gynecology and associate professor at Mayo Clinic, told Healio. “Meaning, when we compare people with chronic pelvic pain to people without chronic pelvic pain who have the same diseases like hypertension, depression or diabetes, the patients with chronic pelvic pain are going to more office appointments and ED visits and have more tests and hysterectomies, all leading up to an annual cost on average of $12,254 per year.”

Green and colleagues analyzed data from 2016 to 2019 from the OptumLabs Data Warehouse on 18,400 women (mean age, 52 years; 66% white) with a first medical claim for chronic pelvic pain. Researchers assessed health care utilization for 12 months after diagnosis and compared utilization between women with and without chronic pelvic pain.

Women with vs. without chronic pelvic pain had higher rates of health care utilization across all indices (P < .001 for all) with more office visits of 10 or more (55.5% vs. 27.4%), ED visits of 10 or more (13.1% vs. 4.8%) and hospitalizations of two or more (6.6% vs. 4.1%). In addition, women with chronic pelvic pain had more diagnostic testing (P < .001 for all). The most common tests were urine culture (42.4%), followed by pelvic ultrasonography (32.8%) and pelvic CT (26.3%). Women with vs. without chronic pelvic pain also had higher rates of hysterectomy (8.9% vs. 0.6%; P < .001), and 5.9% of women with chronic pelvic pain underwent laparoscopic fulguration of endometriosis.

Researchers observed higher rates of overlapping chronic pain conditions among women with vs. without chronic pelvic pain (P < .001 for all). The most diagnosed chronic overlapping conditions were chronic low back pain (39.7% vs. 13.8%), migraine (10.7% vs. 4.8%) and fibromyalgia (9% vs. 3.4%).

Opiates were the most prescribed medication among women with chronic pelvic pain compared with women without (24.7% vs. 7.3%), followed by antibiotics (18.2% vs. 10.3%) and neuromodulators (12.2% vs. 3.8%; P < .001 for all).

“We saw that patients with chronic pelvic pain had a higher utilization of the ED and higher rates of repeat testing including repeat ultrasound and repeat CT scans within a year. These may be areas of overutilization that we could target in our clinical practice and require further study and guidelines,” Green said. “We should consider the utility of repeat imaging in evaluating patients with chronic pelvic pain. We need to explore methods for more ideal utilization of the ED and study interventions used in other clinical scenarios over possible ED overutilization, such as care plans, ED decision support programs, online case management for patients and use of cognitive behavioral therapy, primary care referrals or case management.”

For more information:

Isabel Green, MD, MEHP, can be reached at green.isabel@mayo.edu.