Perioperative complications of outpatient surgery for endometriosis.

Patient selection for day surgery of endometriosis requires more attention.

Key Points

Importance:

• Advanced endometriosis surgery requires highly skilled surgeons and a multidisciplinary approach to ensure the optimal perioperative complication rate.

Highlights:

• Increased perioperative complications of day-surgery endometriosis are correlated with older ages, major surgeries, and extended surgical dissections. 

What's done here:

• A Canadian author team conducted a retrospective cohort study using the Canadian National Ambulatory Care Reporting System (NACRS) data.
• The study aimed to evaluate the perioperative complications of endometriosis "day surgery" in patients aged 15-44.
• Over five years, almost seventeen thousand women who underwent day surgery for endometriosis (56,7% major, and 39,22%minor conservative surgery) were evaluated.
• The association between potential determinants such as age, endometriosis lesion site, type of surgical intervention, and other complications was assessed.

Key Results:

• Perioperative complications were 6%, and the higher risk of complications was related to greater ages.
• Other higher risks of complications were observed when hysterectomies compared to minor conservative surgeries, mostly infections, urinary tract complications, and accidental damage (12%, 27%, and 61%, respectively).
• Endometriotic lesions of the bowels-urinary or extrapelvic sites also had a higher risk of complications in day-surgery operations.

Limitations and strengths:

• The large sample of day surgeries and satisfactory statistical data are the study's strengths.
• The absence of some data during evaluation and the delayed complications of these operations are the limitations.

Lay Summary

Surgical treatment of endometriosis plays an essential role in managing the disease. They are miscellaneous perioperative complications such as incomplete removal of the lesions, low quality of the first surgery, or incorrect approach to laparoscopic surgeries that result in increased recurrence risks. In this case, outpatient laparoscopic surgery approach to cases with endometriosis may even associated with a higher risk of complications.

Bahrami et al. from the Reproductive, Mother, and Child Unit of the Department of Obstetrics and Gynecology of Laval University, Quebec, Canada, aimed to identify the patient characteristics and perioperative complications of "day surgery" for endometriosis and to estimate the relative importance of these determinants. The authors used the National NACRS system to find the patients who underwent outpatient surgery over five years in Canada. Data from approximately 17,000 patients with endometriosis between the ages of 15 to 44 years were assessed.

The results of the study indicated age and surgical interventions were the most important predictors of the model. They underlined that major conservative surgeries such as hysterectomies proposed a greater risk of complications than minor traditional surgeries. Also, perioperative complication risks were higher in patients with bowel-urinary endometriosis and extra-pelvic sites of endometriosis.

The authors recommended taking care of the patient's characteristics and avoiding possible major operations to decrease the perioperative complication risk of day surgeries for endometriosis. This large-population-based retrospective study was recently published in the Journal Obstetrics and Gynaecology Canada.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37741619/