Obstetrics & Gynaecology Society, University of Cambridge School of Clinical Medicine, Cambridge, UK 
Correspondence to: Elena-Georgiana Capbun, egc37@cam.ac.uk
Additional information
- Ethical approval: N/a
- Consent: N/a
- Funding: No industry funding
- Conflicts of interest: N/a
- Author contribution: as per abstract – Conceptualization, Writing – original draft, review and editing
- Guarantor: Elena-Georgiana Capbun
- Provenance and peer-review:
Unsolicited and externally peer-reviewed - Data availability statement: N/a
Keywords: Obstetrics & Gynaecology
Peer-review
Received: 26 March 2025
Accepted: 5 April 2025
Published: 16 April 2025
The Impact of Endometriosis Surgery on Quality-of-Life Scores
Amy Stretch1, Saikat Banerjee2, Emily Gelson2, Giulia Gremmo2,3 and Mohamed Mabrouk4
1. University of Cambridge, Cambridge, United Kingdom
2. Department of Obstetrics and Gynaecology, CEES-u (Cambridge Endometriosis and Endoscopic Unit), Cambridge University Hospitals, Hospital Filippo del Ponte, Cambridge, United Kingdom
3. University of Insubria, Varese, Italy
4. University College Hospitals, London, United Kingdom
Correspondence to: Amy Stretch, amystretch03@gmail.com
Abstract
Introduction: Endometriosis is a chronic condition that impacts women’s lives and often causes persistent pain.1 Previous studies showed that surgical intervention improves pain and quality of life (QoL), but few examined non-response patterns to specific questionnaire items.2–4 The response rates of EuroQol-visual analogue scales (EQ-VAS) have been researched in other clinical contexts, but there is limited analysis for the responses in BSGE pelvic pain questionnaires.5 This study is part of a larger surgical database that aims to inform treatment for patients with endometriosis. My analysis of these data highlights the importance of evaluating data collection methods to ensure that patient QoL responses are not lost.
Objective: The primary objective of this study was to evaluate whether endometriosis surgery improves global pain scores and QoL. We also aimed to assess the effect of non-response on these measurements, as understanding the factors that may influence patient responses is crucial for interpreting the outcomes of surgical interventions for endometriosis.
Methods: A prospective cohort study was conducted at the Cambridge Endometriosis Endoscopic Surgery Unit, Addenbrooke’s Hospital. Patients completed modified BSGE pelvic pain Paper questionnaires before surgery and 12 months post-operatively to assess QoL and pain scores. Preoperative and postoperative scores were compared using Wilcoxon signed rank test and considered significant if the p value ≤0.005. The practical significance of these data was tested by effect size, where a Cohen’s value d ≥ 0.8 showed a large change in the scores. The difference in response rate between questions of the initial paper questionnaire was tested using Fisher’s exact test.
Results: A total of 176 patients completed the initial questionnaire, but only 33 had complete data and were included in the prospective cohort. Loss of data occurred largely due to a lack of response, especially to the QoL question (Figure 1).
In the 33 patients, significant improvements were seen, as shown below (Table 1). Scores for anxiety & depression, self-care and mobility failed to show statistical significance. Importantly, overall quality of life showed improvement postoperatively (Figure 2).
Implications: Previous studies have confirmed the improvements in QoL and global pain scores following endometriosis surgery. Initially, this project was an audit to compare surgical outcomes at Addenbrooke’s Hospital, but it was hindered by the low response rate to the QoL questions. This limitation prevents meaningful conclusions about a patient’s changes in life following surgery. The study underscores the need to optimize questionnaire design for this patient population. Future research should focus on modifying the questionnaire to obtain a more accurate assessment of the impact of endometriosis surgery on QoL, which could lead to significant improvements in patient care.
| Table 1: Comparison of preoperative and 12-months postoperative outcomes across the EQ-5D health domains. Statistically significant improvements were observed in QoL, usual activities, pain & discomfort, and global scores at 12 months postoperatively (P < 0.005). Data are presented as mean ± standard deviation. | ||||
| Item | Preoperative Score Mean | 12 Months Postoperative Score Mean | P-Value | Effect Size |
| QoL (EQ-VAS) | 45 ± 19 | 63 ± 22 | 0.0005 | 0.96 |
| Usual Activities | 2.1 ± 0.51 | 1.7 ± 0.68 | 0.0032 | −0.89 |
| Anxiety & Depression | 2.0 ± 0.59 | 1.9 ± 0.70 | 0.96 | −0.05 |
| Self-Care | 1.3 ± 0.52 | 1.4 ± 0.60 | 0.56 | 0.17 |
| Pain & Discomfort | 2.5 ± 0.51 | 2.0 ± 0.68 | 0.0038 | −0.83 |
| Mobility | 1.7 ± 0.74 | 1.6 ± 0.62 | 0.53 | −0.16 |
| Global Scores | 50 ± 17 | 26 ± 19 | <0.0001 | −1.46 |
References
- Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. The social and psychological impact of endometriosis on women’s lives: A critical narrative review. Human Reprod Update. 2013;19:625–39. https://doi.org/10.1093/humupd/dmt027
- Ahmad MF, Narwani H, Shuhaila A. An evaluation of quality of life in women with endometriosis who underwent primary surgery: A 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia. J Obstet Gynaecol. 2017;37:906–11. https://doi.org/10.1080/01443615.2017.1312302
- Batsu-Bastu E, Celik HG, Kocyigit Y, Yozgatli D, Yasa C, Ozaltin S, et al. Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: A retrospective cohort study. Arch Gynecol Obstet. 2020;302:165–72. https://doi.org/10.1007/s00404-020-05583-6
- Kristensen J, Jørgen Kjer J. Laparoscopic laser resection of rectovaginal pouch and rectovaginal septum endometriosis: The impact on pelvic pain and quality of life. Acta Obstet Gynecol Scand. 2007;86:1467–71. https://doi.org/10.1080/00016340701645006
- Feng Y, Parkin D, Devlin NJ. Assessing the performance of the EQ-VAS in the NHS PROMs programme. Qual Life Res. 2014;23:977–89. https://doi.org/10.1007/s11136-013-0537-z
Rational Prescribing? Perioperative Antibiotic Audit in the Busiest Maternity Hospital in Uganda
Emma Guenther1, Eleanor Turnbull-Jones2, Katherine Sharrocks2, Charlotte Patient2 and Musa Sekikubo3
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Makerere University School of Medicine, Kampala, Uganda
Correspondence to: Emma Guenther, emma.guenther2000@gmail.com
Abstract
Background: Puerperal sepsis, a major cause of maternal mortality post caesarean section (CS) globally,1 can be prevented by adhering to World Health Organization (WHO) guidelines.2 These guidelines recommend a single dose of antibiotic prophylaxis pre-operatively to reduce infection risk. However, overprescribing empiric antibiotics is a common practice3 that can lead to increased rates of antimicrobial resistance (AMR). This poses significant global public health and developmental threats and results in greater economic costs, underscoring the broader implications of this research.
Aims: To review adherence to WHO guidelines for prophylactic antibiotics in CS patients at Kawempe National Referral Hospital, an urban obstetrics and gynecology hospital in Kampala, Uganda.
Method: A chart review of anonymous electronic health data was completed for 100 CS patients over 1 week in July 2024 on the postnatal ward in Kawempe Hospital, documenting age, reason for CS, and post-surgical outcomes. Pre-surgery, post-surgery, and discharge antibiotics, including dose, route of administration, and duration, were meticulously recorded. A week later, follow-up was conducted to identify if any patients had been readmitted with sepsis or wound infections, ensuring a comprehensive understanding of the post-operative period.
Results: Of the 100 patients, 91% had an emergency CS, the most common indication being obstructed labor. Three patients were readmitted with wound infection at follow-up. Table 1 summarizes the antibiotics prescribed. Only 49% of patients had a documented single dose of antibiotic prophylaxis pre-operatively, while 100% had post-operative antibiotics. The average number of days of ceftriaxone administration post-operatively was 2.63 (range 1–7), whereas the average for metronidazole was 1.91 (range 1–5). Three patients were readmitted due to wound infections or sepsis during the 1-week follow-up.
Conclusion: Kawempe National Referral Hospital does not adhere to WHO guidelines regarding prophylaxis for CS patients, as only 50% of the patients receive prophylactic antibiotics. Strikingly, all patients were administered antibiotics postoperatively, with more than two-thirds receiving medications intravenously. Evidence shows that post-operative antibiotics do not significantly impact post-CS infection risk and may contribute to antimicrobial resistance.4 Adhering to WHO recommendations by enhancing staff and patient education could save considerable hospital resources and staff time, enabling their redistribution for broader accessibility. This is a crucial advancement in the worldwide battle against AMR.
| Table 1: Summary of peri-operative antibiotic prescribing. | ||
| Medication | No. of Patients (n = 100) | |
| Pre-operative (C-section) | IV ceftriaxone | 49 |
| Not documented | 51 | |
| Post-operatively (C-section) | IV metronidazole and ceftriaxone | 69 |
| Alternative combination | 31 | |
| Discharge | PO metronidazole and ampicillin/cloxacillin | 53 |
| PO metronidazole and cefixime | 19 | |
| Alternative combination | 28 | |
References
- Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: Global and regional estimates. BMJ Global Health. 2021;6(6):e005671. Available from: https://doi.org/10.1136/bmjgh-2021-005671
- WHO recommendation on prophylactic antibiotics for women undergoing caesarean section (updated 2021). Available from: https://www.who.int/publications/i/item/9789240028012 (Accessed: 1st October 2024).
- Antimicrobial Resistance (updated Nov 2023). Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (Accessed: 2nd October 2024).
- Al Meslamani AZ. Antibiotic resistance in low- and middle-income countries: Current practices and global implications. Expert Rev Anti Infect Ther. 2023;21(12):1281–6. Available from: https://doi.org/10.1080/14787210.2023.2268835
