Comparing Characteristics of and Postoperative Morbidity after Hysterectomy for Endometriosis versus other Benign Indications: A NSQIP Study

Kelsey A. Stewart, Katelyn M. Tessier, Dan I Lebovic

Research output: Contribution to journalArticlepeer-review

Abstract

STUDY OBJECTIVE: Compare the difference in postoperative morbidity for benign total hysterectomy by indication.

DESIGN: Retrospective cohort.

SETTING: United States hospitals participating in the American College of Surgeons National Surgical Quality Improvement Project database from 2018 to 2019.

PATIENTS: Patients undergoing total hysterectomy for benign indications age 18 to 55 years old.

INTERVENTIONS: Univariate comparisons were made between patients with hysterectomies for endometriosis and other benign indications. Unadjusted and adjusted logistic regression models were used to investigate the association between primary outcomes and hysterectomy indication; covariates in the adjusted model include age, race, ethnicity, and route.

MEASUREMENTS AND MAIN RESULTS: A total of 29 742 women underwent hysterectomies, of which 3596 (12.1%) were performed for endometriosis. Patients undergoing hysterectomy for endometriosis were likely to be younger, were predominately White, and had less comorbidities. They were also more likely to have previous abdominal surgery, have previous pelvic surgery, undergo a laparoscopic approach, and undergo lysis of adhesions (all p <.001). Overall length of stay (≥1 day 73.1% vs 78.6%; p = .983) and operative time (median 118.0 vs 125.0 minutes; p <.001) were similar in both groups. Examining primary outcomes, patients with endometriosis were more likely to experience major morbidity (3.8% vs 3.4%; adjusted odds ratio [OR], 1.25; p = .033), with no difference in minor or overall morbidity (5.8% vs 6.9% [p = .874] and 8.8% vs 9.4% [p = .185], respectively). There were two 30-day mortalities, none in the endometriosis group. Patients with endometriosis were more likely to develop deep surgical site infection (SSI)/organ-space infection (2.3% vs 1.6%; OR, 1.42; p = .024) and less likely to receive blood transfusion (1.8% vs 3.0%; OR, 0.58; p <.001). There was no difference in occurrence of superficial SSI, sepsis, venous thromboembolism, readmission, or reoperation between groups.

CONCLUSION: Patients undergoing hysterectomy for endometriosis were more likely to experience major morbidity and deep SSI, although overall major morbidity is rare.

Original languageEnglish (US)
Pages (from-to)884-890.e2
JournalJournal of Minimally Invasive Gynecology
Volume29
Issue number7
DOIs
StatePublished - Jul 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Institutes of Health grant P30 CA77598 using the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and by the National Center for Advancing Translational Sciences of the National Institutes of Health award number UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Thank you to the University of Minnesota Department of Obstetrics, Gynecology, and Women's Health for support.

Publisher Copyright:
© 2022 AAGL

Keywords

  • Endometriosis
  • Hysterectomy
  • Infection
  • Morbidity
  • NSQIP

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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