Association between Endometriosis and Surgical Complications among Benign Hysterectomies

Study Objective: To investigate the effect of endometriosis on perioperative outcomes in patients undergoing hysterectomy for benign disease. Design: A retrospective cohort study. Setting: The American College of Surgeons National Surgical Quality Improvement Program database. Patients: A total of 127 556 hysterectomies performed for benign gynecologic indications Interventions: Differences in the primary outcomes were compared between patients with and without endometriosis after adjustment for group differences in covariates using inverse probability of treatment weighting approach. Measures and Main Results: Of the 127 556 hysterectomies identified, 19 618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger with a lower prevalence of chronic comorbidities but had higher rates of concurrent pelvic inflammatory disease and previous abdominal operations. The incidence of postoperative complications was higher in patients with endometriosis (9.9% vs 8.1%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.17–1.34). The incidence of 30-day mortality (0.1% vs 0.03%; OR, 1.98; 95% CI, 0.69–5.65) and reoperations (1.50% vs 1.36%; OR, 1.18; 95% CI, 0.98–1.42) were not different in patients with and without endometriosis. Conclusion: Postoperative complications are more likely in hysterectomies involving endometriosis than those without endometriosis, likely owing to anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of the increased risk of complications and plan for mitigating these increased risks before and during surgery for suspected endometriosis.