Risk of Surgical Site Infection After Clean Laparoscopy for Endometriosis

STUDY OBJECTIVE: Assess the surgical site infection (SSI) risk of clean benign gynecologic laparoscopy for endometriosis. DESIGN: Retrospective cohort. SETTING: National Surgical Quality Improvement Program hospitals, 2019 to 2022. PATIENTS: Patients aged 16 to 55 years undergoing gynecologic laparoscopy. Endometriosis cases were compared with other indications (ovarian cyst, tubal ligation, or prophylaxis for hereditary cancer). Procedures with entry into any visceral tract, malignancy, myomectomy, prolapse repair, or laparotomy were excluded. INTERVENTIONS: The primary outcome was 30-day SSI. Multivariable regression was adjusted for demographic and clinical factors. MEASUREMENTS AND MAIN RESULTS: There were 5684 patients (18.9%) who underwent clean gynecologic laparoscopy for endometriosis and 24 428 (81.1%) for other benign indications. Patients with endometriosis were younger, had lower body mass index (p <.001), and had longer procedures (15.7% and 3.0% ≥120 minutes; p <.0001). SSI occurred in 1.8% of patients: 1.5% superficial and 0.2% organ/space. Endometriosis cases had higher SSI (2.3% and 1.6%; p = .0005), including superficial (1.9% and 1.5%; p = .0217) and organ/space (0.4% and 0.2%; p = .0003). The highest SSI rates occurred with endometriosis adnexal surgery (3.1%), nonendometrioma cystectomy (2.6%), and endometriosis excision (2.2%) (p <.0001). Readmission for endometriosis was more frequent (1.2% and 0.6%; p = .0001), but not reoperation (0.4% and 0.3%; p = .087). Operating time for endometriosis was longer (76.3 vs 44.8 minutes; p <.0001), although infection rate increased with duration in both groups (p <.001; p = .013). The association between endometriosis and SSI remained significant after adjustment for age, race, body mass index, comorbidities, operating time, year, and concurrent procedures (adjusted odds ratio, 1.31; 95% confidence interval, 1.04-1.64). CONCLUSION: Clean gynecologic laparoscopy for endometriosis carries higher SSI and readmission risk, especially for adnexal surgery or prolonged procedures. Future research should evaluate the effect of antibiotic prophylaxis in this group.