Defining Surgical Success in Endometriosis: A Patient-Centered Pilot Study

This study aimed to define surgical success in patients with endometriosis from a patient-centered perspective and determine the improvement in pain and quality of life that patients consider indicative of a successful surgical outcome.

This pilot study included a sample of 36 patients with symptomatic endometriosis and with scheduled surgery at Laval University Hospital Center (Québec, Canada), a tertiary referral center for endometriosis. Patients completed an online survey addressing their definitions of surgical success and surgical failure, as well as their baseline symptoms and the minimal improvement they would expect in various domains related to pain and quality of life. Mixed method combining qualitative and quantitative data was used. Absolute and relative differences between preoperative and expected postoperative scores for each domain were analyzed.

Ninety-seven percent of patients (n = 35) identified improvement in quality of life as the main determinant of surgical success, while no consensus emerged regarding the definition of surgical failure. The mean minimal expected reduction in Endometriosis Health Profile (EHP-30) score was 34 points (95%CI 26.7-40.4; P < 0.001). Most patients (91.7%) expected a postoperative EHP-30 score below 40, regardless of their baseline score. Overall, patients expected a 52%-69% reduction in pain symptom scores.

The most important patient-reported outcome defining surgical success was improvement in quality of life, with the majority of patients aiming for an EHP-30 score below 40 after surgery. The use of a defined threshold may help establish a standardized definition of surgical success in future clinical practice and research on endometriosis.