Effect of Endometriosis on Postoperative Outcomes After Hysterectomy Performed for Benign Gynecologic Disease [A115]

INTRODUCTION: Endometriosis affects 10% of reproductive-aged women. Its impact on complications after gynecologic surgery is, however, not well known. This study aimed to investigate the effect of endometriosis on perioperative outcomes of patients undergoing hysterectomy for benign disease. METHODS: Institutional Review Board (IRB) approval was obtained. The 2014-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were used to select patients undergoing elective hysterectomy performed for benign indications. Propensity scores derived from logistic regression and inverse probability treatment weighting analysis were used to assemble weighted samples of patients with and without endometriosis. Primary outcomes included 30-day mortality, postoperative complications, and reoperations. Binary logistic regression was used to compare differences in the primary outcomes between patients with and without endometriosis. RESULTS: A total of 127,556 hysterectomy cases were identified. Of those, 19,618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger, had higher incidence of pelvic inflammatory disease and prior abdominal operations but lower prevalence of chronic comorbidities. The incidence of postoperative complications was higher in patients with endometriosis (9.3% vs. 8.4%; OR[95% CI], 1.12 [1.05-1.20]; P =.001). However, the incidence of 30-day mortality (0.04% vs. 0.03%; OR [95% CI],1.16 [0.38-3.52]; P =.789) and reoperations (1.50% vs. 1.36%; OR [95% CI, 1.11 [0.92-1.33]; P =.287) were not different in patients with and without endometriosis. CONCLUSION: The rate of postoperative complications was higher in hysterectomies involving endometriosis compared to hysterectomies without endometriosis. Likely this is due to the anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of this increased risk when planning surgery for suspected endometriosis.