Endometriosis is a chronic, systemic inflammatory condition affecting women of reproductive age worldwide, with a prevalence of 5–10% (1). It is associated with dysmenorrhea, non-cyclic pelvic pain, dyspareunia, dyschezia, infertility, and adverse obstetric outcomes (1).

Surgical intervention is indicated for persistent symptoms despite hormonal treatment, infertility, or specific lesions such as subocclusive rectosigmoid, ureteral, or small bowel involvement. Surgical approaches range from excision of superficial endometriosis to deep endometriosis resection with nerve-sparing techniques, which may involve bowel or bladder resection. (2). While 20–30% of patients experience symptomatic relief following laparoscopy, symptoms persist or recur in 20–40% of cases (3).

Given its high prevalence and significant impact on physical function, daily activities, and quality of life, endometriosis imposes a substantial social and economic burden that includes direct and indirect costs (4). Direct costs encompass hospitalization, outpatient procedures, consultations, surgeries, medications, and healthcare services, and has been reported to be of approximately $8,000 to $12,000 for endometriosis-related hospitalization (5, 6, 7). Indirect costs include productivity loss, absenteeism, disability, reduced leisure time, and quality of life, and depending on the country and disease severity it may range from $279.63 to $9,910.39 (5,7).

Several studies suggest that the total economic burden of endometriosis may reach approximately $20,989 per patient, comparable to or exceeding that of other chronic conditions such as heart disease and diabetes (5,7). In this context, this study was conducted among women receiving care in the public healthcare system at a tertiary hospital in São Paulo, Brazil. The objective was to evaluate the clinical and demographic characteristics of patients undergoing endometriosis surgery in the public healthcare system, assess the direct costs related to low- and high-complexity procedures, and identify the principal clinical and procedural determinants of increased surgical expenditure.