The national acceptance of pelvic congestion syndrome among other common venous pathologies

Pelvic congestion syndrome (PCS) is characterized by chronic pelvic pain persisting for over 6 months that is exacerbated by sexual activity, menstruation, and prolonged standing. PCS is associated with ovarian and iliac varicose veins (VV) and primarily affects female patients of childbearing age, often resolving at menopause. The purpose of this study is to detect national trends of PCS, in comparison with other common venous pathologies, chronic venous insufficiency (CVI), and VV.

Patient data were collected from the Healthcare Cost and Utilization Project's National Inpatient Sample 2004 to 2021, bridging International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for PCS (ICD-9, 625.5; ICD-10, N94.89), CVI (ICD9, 459.8; ICD-10, I87.2), VV (ICD-9, 454.x; ICD-10, I83.x), and pelvic varices (ICD-9, 456.5-6; ICD-10, I86.2-3), were isolated for analysis. Data extraction and statistical programming were conducted via Stata version 17.0 (StataCorp LLC).

During the years using the ICD-9 coding system, the prevalence of PCS decreased. However, with the transition to ICD-10, PCS prevalence began to rise, continuing to increase through 2021, from 8605 cases in 2016 to 9250 cases in 2021. Similarly, the prevalence of VV and CVI showed an increasing trend across the ICD-9 to ICD-10 transition period. VV cases rose from 44,185 in 2004 to 71,180 in 2021, and CVI cases increased from 173,430 to 232,850 over the same period. In contrast, the prevalence of pelvic varices decreased, from 2185 cases in 2004 to 990 cases in 2021. In addition, no major trends were observed in the prevalence of inpatient abdominal venous procedures or leg venous procedures, indicating a stable incidence rate for these conditions.

This study highlights the rising prevalence of PCS, particularly the growth in national inpatient diagnoses following the transition to the ICD-10 coding system. This upward trend likely reflects improved recognition and coding rather than a true surge in incidence. The increasing trends in these venous conditions underscore the need for heightened clinical awareness and targeted interventions to manage these conditions effectively. As the National Inpatient Sample captures only hospitalized patients, these findings should be interpreted as inpatient diagnostic trends and do not fully represent the overall prevalence or outpatient management of PCS.