Surgical management of endometriosis in adolescents versus adults: a National Surgical Quality Improvement Program...

To compare the postoperative diagnoses and the types of surgical intervention, excluding hysterectomy, between adolescents and adults receiving endometriosis surgery.

Retrospective cohort study.

Adolescents (aged <18 years) and adults (aged 18-50 years) with a postoperative diagnosis of endometriosis (excluding adenomyosis/endometriosis of the uterus) based on International Classification of Diseases codes, who received endometriosis surgery in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases (2012-2021).

Endometriosis surgery, excluding hysterectomy, identified by Current Procedural Terminology codes.

Postoperative diagnoses, uterine-sparing endometriosis procedures, and 30-day postoperative complications between age groups.

We identified 291 adolescents, median age 17 years (IQR, 15-17 years), and 8,785 adults, median age 34 years (IQR, 28-39 years), who underwent uterine-sparing surgery with a postoperative diagnosis of endometriosis. Most adolescents (78%) and adults (60%) were White, although adults were significantly more diverse across racial groups and ethnic groups (6% vs. 10%). A higher proportion of surgeries in adolescents were for peritoneal endometriosis (65% vs. 35%), whereas more adults underwent surgery for endometrioma (10% vs. 26%) or other endometriosis subtypes (25% vs. 39%). Laparoscopic excision/destruction of lesions was the most common procedure performed in adolescents (75%). Although this remained the most common procedure in adults (59%), their endometriosis diagnoses were associated with a more diverse range of procedures. Diagnostic laparoscopy was more commonly performed in adolescents and rarely in adults (20% vs. 2%). Thirty-day complications were rare in both groups.

Adolescents were more likely to undergo diagnostic laparoscopy or laparoscopic excision/destruction of lesions and be diagnosed with peritoneal endometriosis, whereas adults underwent a more diverse range of procedures for varied subtypes. Complications for endometriosis procedures were rare. Our findings support the notion of distinct variation in endometriosis between these age groups.