Determinants of Perioperative Complications in Day-Surgery for Endometriosis: A Retrospective Cohort

Abstract

<h3>Study Objective</h3> In this study, we aimed to evaluate the potential determinants of perioperative complications in day surgeries for endometriosis. <h3>Design</h3> A retrospective cohort study. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> We used data from the Canadian administrative data from the National Ambulatory Care Reporting System (NACRS) maintained by the Canadian Institute for Health Information (CIHI). 16,982 women aged 15-44 years undergoing day-surgery for endometriosis between 2015 and 2019 were eligible. <h3>Interventions</h3> Surgeries were categorized as minor conservative (e.g., biopsy or minor adhesiolysis) or major conservative surgeries (e.g., lesion excision or resections) or hysterectomies. <h3>Measurements and Main Results</h3> 16,982 patients underwent day-surgery over the five-years study period. We observed a higher risk of complications associated with greater age (OR=1.58; 95%CI 1.26-1.98); hysterectomies (OR=2.29; 95%CI 1.73-3.06); lesions of the bowel or urinary tract system (OR=1.54; 95%CI 1.16-2.06), and extra-pelvic sites of endometriosis (OR=1.24; 95%CI 1.07-1.52); and with centers of higher volume (OR=1.59; 95%CI 1.09- 2.32). The odds of infections were higher among patients undergoing hysterectomies (OR=8.56; 95%CI 4.70- 15.59); and lower among patients with ovarian endometriosis (OR=0.44; 95%CI 0.24- 0.78). The odds of renal complications were significantly higher among older patients (OR=1.57; 95%CI 1.01- 2.45), and among patients with lesions in miscellaneous sites (OR=1.75; 95%CI 1.24- 2.48). The odds of complications such as accidental cut, puncture, perforation, or laceration were higher in older patients (OR=1.57; 95%CI 1.18- 2.10); among those undergoing major conservative surgery (OR=1.57; 95%CI 1.31- 1.89) or hysterectomy (OR=2.31; 95%CI 1.70- 3.14); in the context of bowel or urinary tract system endometriosis (OR=1.84; 95%CI 1.43 -2.37); and in high-volume centers (OR=1.82; 95%CI 1.22- 2.72). <h3>Conclusion</h3> Age, hysterectomy, endometriosis of the bowel, urinary tract system and extra-pelvic sites, and high-volume center increase the risk of complications. Determinants of complications can inform care by improving the recognition of patients at greater risk.