Comparing Characteristics and Postoperative Outcomes of Hysterectomy for Endometriosis Versus Other Benign Indications: A NSQIP Study

Abstract

<h3>Study Objective</h3> Endometriosis is known to cause mild to significant intra-abdominal adhesions, theoretically making surgical procedures more challenging. However, little comparative surgical outcomes data is available. <h3>Design</h3> The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was searched from 2018 to 2019 for all total hysterectomies. Hysterectomies for malignant conditions, emergent cases, and cases with pre-operative morbidity were excluded. Univariate comparisons were made between patients with hysterectomies for endometriosis vs other benign indications (abnormal bleeding, leiomyoma, prolapse, and pelvic pain). Unadjusted and adjusted logistic regression models were used to investigate the association between primary outcomes and hysterectomy indication, with covariates in the adjusted model including age, race, ethnicity and surgical route. <h3>Setting</h3> Within 30 days post operative. <h3>Patients or Participants</h3> Patients undergoing hysterectomy 18-55 years old. <h3>Interventions</h3> Hysterectomy. <h3>Measurements and Main Results</h3> A total of 29,742 women underwent hysterectomies, of which 3,596 (12.1%) were performed for endometriosis. Patients undergoing hysterectomy for endometriosis were statistically likely to be younger, predominately white, and had lower BMI. They were also more likely to have had prior abdominal surgery, prior pelvic surgery, undergo a laparoscopic approach, and undergo lysis of adhesions (all p<0.001). Overall length of stay (1.1 vs 1.2 days, p<0.001) and operative time (130.8 vs 136.8 minutes, p<0.001) were lower in patients undergoing hysterectomy for endometriosis. Examining primary outcomes, patients with endometriosis were more likely to experience major morbidity (AOR 1.25, p=0.033), with no difference in minor morbidity (p=0.87). There were two mortalities. Endometriosis patients were more likely to develop deep surgical site infection (SSI) (OR 1.42, p=0.004), and less likely to receive blood transfusion (OR 0.58, p<0.001). There was no significant difference in occurrence of superficial SSI, sepsis, venous thromboembolism, readmission or re-operation between groups. <h3>Conclusion</h3> Patients undergoing hysterectomy for endometriosis were more likely to experience major morbidity and deep surgical site infection compared to patients with other benign indications.