Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women

Abstract

study question: What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women? summary answer: Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery. what is known already: The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before.However, previous studies focus onmedical benchmarkswithout including the patient's perspective in a quantitativemanner. study design, size, duration: A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013. participants/materials, setting,methods:Women diagnosedwith endometriosis andwith at leastone specific laparoscopic surgery inthepastwereenrolledin thestudy.Thestudy investigatedtheeffect of theminimally invasivesurgeryonhealthandonqualityofwork life of affected women. Questions used were obtained from theWorld Endometriosis Research Foundation (WERF) Global Study onWomen's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study. main results and the role of chance: Of the 587women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%)were included in the study.Our data showthat 62%(n = 130) of the studypopulationdeclaredendometriosis as influencing the jobduring theperiodprior tosurgery, comparedwith 28%after surgery (P< 0.001).Themean (maximal) absence fromworkduetoendometriosiswas reducedfrom2.0(4.9) to0.5(1.4) hoursperweek (P < 0.001). The mean (maximal) loss inworking performance after the surgery averaged out at 5.7%(12.6%) comparedwith 17.5%(30.5%) before this treatment (P < 0.001). limitations, reasons for caution: Themediocre response rate of the study weakens the representativeness of the investigated population.Considering the anonymous setting a non-responder investigationwas not performed.Abias due to selection, information and negativity effectswithin a retrospective survey cannot be excluded, although study-sensitive questionswere provided inmultipleways.The absence of a control group (sham group; e.g. patients undergoing specific diagnostic laparoscopy without treatment) is a further limitation of the study. wider implications of the findings: Our study shows that indicated minimally invasive surgery has a clear positive effect on the wellbeing andworking performance of women suffering frommoderate to severe endometriosis. Furthermore, national net savings in indirect costs with the present number of surgeries is estimated to beE10.7million per year. In an idealized setting (i.e.without any diagnosis delay) this figure could be more than doubled. study funding/competing interest(s): The studywasperformed onbehalf of theUniversityHospitalofBern (Inselspital) asone of the leading Swiss tertiary care centers. The authors do not declare any competing interests.