Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease

Abstract

Study Objective To compare complications in patients undergoing laparoscopic versus open surgery for acute pelvic inflammatory disease (PID). Design We performed a retrospective cohort study of patients who underwent surgery for PID using the National Surgical Quality Improvement Program database from 2010-2015. Propensity-score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic versus open surgery. Setting Surgical management of acute PID. Patients or Participants Patients with preoperative diagnosis of PID were identified using ICD-9 codes. We excluded patients with a diagnosis of chronic PID, with gynecologic malignancy, and those whom the surgical route was unknown. Interventions Surgery for acute PID. Measurements and Main Results The study population was comprised of 367 patients. The mean age was 43.0±11.1 years, BMI was 29.4 (IQR 24.3-36.7), and ASA class was 2 (IQR 2-3). Preoperative sepsis was noted in 32.4%, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 115 patients (31.3%), 14 (3.8%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (aOR 0.55, p=0.04), hysterectomy (aOR 1.87, p=0.05), appendectomy (aOR 2.6, p=0.03), preoperative hematocrit < 30g/dl (aOR 2.68, p<0.01), preoperative INR > 1.2 (aOR 2.44, p<0.01), and operative time (aOR 1.004, p=0.02). Propensity-scores were calculated and utilized to generate a matched cohort of laparoscopic versus open surgery; groups were similar with p<0.05 for all covariates. After balancing potentially confounding variables, the composite complication rate remained lower in patients who underwent laparoscopy (20.5%) versus open surgery (35.2%), p=0.04. Conclusion Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID. To compare complications in patients undergoing laparoscopic versus open surgery for acute pelvic inflammatory disease (PID). We performed a retrospective cohort study of patients who underwent surgery for PID using the National Surgical Quality Improvement Program database from 2010-2015. Propensity-score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic versus open surgery. Surgical management of acute PID. Patients with preoperative diagnosis of PID were identified using ICD-9 codes. We excluded patients with a diagnosis of chronic PID, with gynecologic malignancy, and those whom the surgical route was unknown. Surgery for acute PID. The study population was comprised of 367 patients. The mean age was 43.0±11.1 years, BMI was 29.4 (IQR 24.3-36.7), and ASA class was 2 (IQR 2-3). Preoperative sepsis was noted in 32.4%, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 115 patients (31.3%), 14 (3.8%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (aOR 0.55, p=0.04), hysterectomy (aOR 1.87, p=0.05), appendectomy (aOR 2.6, p=0.03), preoperative hematocrit < 30g/dl (aOR 2.68, p<0.01), preoperative INR > 1.2 (aOR 2.44, p<0.01), and operative time (aOR 1.004, p=0.02). Propensity-scores were calculated and utilized to generate a matched cohort of laparoscopic versus open surgery; groups were similar with p<0.05 for all covariates. After balancing potentially confounding variables, the composite complication rate remained lower in patients who underwent laparoscopy (20.5%) versus open surgery (35.2%), p=0.04. Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.