Impact of age on postoperative outcomes in laparoscopic hysterectomy for endometriosis

OBJECTIVE: This study evaluates the association between patient age and postoperative complications following laparoscopic hysterectomy (LH) for endometriosis and between patient age and operative time. METHODS: A retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program from 2012 to 2020. Patients who underwent laparoscopic or robotic-assisted hysterectomy for endometriosis were included in the study. Age was categorized into four groups: <30, 30-39, 40-49, and ≥50 years. The primary outcome was 30-day postoperative complications, classified as major or minor. The secondary outcome was operative time. Multivariable logistic regression was used to evaluate the association between age and postoperative outcomes. RESULTS: Among 6768 patients, 624 (9.2%) were aged <30 years, 2790 (41.2%) were aged 30-39 years, 2863 (42.3%) were aged 40-49 years, and 491 (7.3%) were aged ≥50 years. Postoperative complications occurred in 8.3% of patients, including 3.6% major and 5.3% minor complications. Compared with patients <30 years, those ≥50 years had significantly lower odds of major complications (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.22-0.95) and any complications (aOR 0.52, 95% CI 0.31-0.89). When stratified at the median age of 39, patients ≥39 years also had lower odds of major complications (aOR 0.73, 95% CI 0.56-0.95). With each year of age, the odds of major complications decreased by 2%, while the likelihood of prolonged surgery increased by 3% (P < 0.001). CONCLUSION: Older age was associated with lower odds of major postoperative complications after LH for endometriosis, despite longer operative times. Further research is needed to clarify the biological, clinical, and selection factors underlying this association.