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

Abstract

ObjectivesEndometriosis is a common gynaecologic disease for which surgery is often required. Our objective was to evaluate the potential determinants of perioperative complications in day-surgeries for endometriosis. MethodsWe conducted a retrospective cohort study of patients undergoing day-surgeries for endometriosis using Canadian administrative data from between 2015 and 2019. A multilevel logistic model with a random intercept at the centre level was created to assess the association between potential determinants, including age, site(s) of endometriosis lesion, centre-volume, surgical intervention, and a composite outcome of complications or specific complications. ResultsWe observed a higher risk of complications associated with greater age (40–44 vs. 20–24 years, adjusted odds ratio [aOR] 1.58; 95% CI 1.26–1.98); hysterectomies (aOR 2.29; 95% CI 1.73–3.06) compared with minor conservative surgery; lesions of the bowel or urinary tract system (aOR 1.54; 95% CI 1.16–2.06), and extra-pelvic sites of endometriosis (aOR 1.24; 95% CI 1.07–1.52) compared with endometriosis of the uterus; and with comorbidities (aOR 1.59; 95% CI 1.09–2.32). Endometriosis lesions to the bowel and urinary tract system and to extra-pelvic sites (compared with no endometriosis at the site) were associated with a greater risk of accidental damages (aOR 1.84; 95% CI 1.43–2.37) and urinary system complications (aOR 1.75; 95% CI 1.24–2.48), respectively. Among patients undergoing hysterectomies compared with those undergoing minor conservative surgery, infectious complications (aOR 8.56; 95% CI 4.70–15.59) and accidental damages (aOR 2.31; 95% CI 1.70–3.14) were more frequent. ConclusionsComplications in day-surgeries for endometriosis are more frequent with older age, hysterectomy, comorbidities, and endometriosis of the bowel, urinary tract system, and extra-pelvic locations. More extensive disease is associated with more extensive surgical dissection and a higher risk of complications.