8942 Development of a Novel Physical Exam for Patients Undergoing Laparoscopic Excision of Endometriosis

Abstract

Study Objective To create and validate a standardized physical exam for patients undergoing laparoscopic excision of endometriosis surgery. Design Prospective observational feasibility study. Setting Large academic hospital. Patients or Participants Patients (n = 17) undergoing operative laparoscopy for management of endometriosis were consented and enrolled before surgery and followed up to 6 weeks postoperatively. This is an ongoing study with plan to enroll 30 participants. Interventions N/A. Measurements and Main Results We developed a physical exam that included numerical pain ratings from regions typically affected by endometriosis. The complete exam was conducted at the preoperative visit and a modified version was performed at 2-week and 6-week postoperative visits for patient comfort. Composite pain scores were calculated from the modified physical exam to quantify physical symptom severity. These scores were compared to a validated patient-reported outcome measure for pain, Brief Pain Inventory (BPI). The composite physical exam pain scores improved progressively following surgery, decreasing from a median of 22.5 (IQR 14-34.29) preoperatively to 11.5 (IQR 5.26-16) at 6-weeks postoperative (p=0.072 using Wilcoxon signed-rank test). This was consistent with a decrease in average pain reported using BPI (p= 0.063). Spearman correlation coefficients showed a moderate correlation between preoperative physical exam scores and BPI (rho = 0.5419). Conclusion Currently, there is no consensus physical exam to describe symptom severity for patients with chronic pelvic pain. We report a novel standard physical exam to describe endometriosis symptom severity. Even though our results were not statistically significant, we observed a reduction in physical exam pain scores reported before and after surgery, which correlated with pain scores collected using a validated pain questionnaire. This proposed exam could be used to objectively follow up success of endometriosis excision. Our study is currently underpowered and anticipate achieving statistical significance after completing recruitment. To create and validate a standardized physical exam for patients undergoing laparoscopic excision of endometriosis surgery. Prospective observational feasibility study. Large academic hospital. Patients (n = 17) undergoing operative laparoscopy for management of endometriosis were consented and enrolled before surgery and followed up to 6 weeks postoperatively. This is an ongoing study with plan to enroll 30 participants. N/A. We developed a physical exam that included numerical pain ratings from regions typically affected by endometriosis. The complete exam was conducted at the preoperative visit and a modified version was performed at 2-week and 6-week postoperative visits for patient comfort. Composite pain scores were calculated from the modified physical exam to quantify physical symptom severity. These scores were compared to a validated patient-reported outcome measure for pain, Brief Pain Inventory (BPI). The composite physical exam pain scores improved progressively following surgery, decreasing from a median of 22.5 (IQR 14-34.29) preoperatively to 11.5 (IQR 5.26-16) at 6-weeks postoperative (p=0.072 using Wilcoxon signed-rank test). This was consistent with a decrease in average pain reported using BPI (p= 0.063). Spearman correlation coefficients showed a moderate correlation between preoperative physical exam scores and BPI (rho = 0.5419). Currently, there is no consensus physical exam to describe symptom severity for patients with chronic pelvic pain. We report a novel standard physical exam to describe endometriosis symptom severity. Even though our results were not statistically significant, we observed a reduction in physical exam pain scores reported before and after surgery, which correlated with pain scores collected using a validated pain questionnaire. This proposed exam could be used to objectively follow up success of endometriosis excision. Our study is currently underpowered and anticipate achieving statistical significance after completing recruitment.