Short‐term outcomes of endometriosis surgery in Ontario: A population‐based cohort study

Abstract

Introduction: Our objective was to compare the short-term outcomes by type of surgical management of endometriosis in Ontario, Canada and to characterize the population of women undergoing surgical management of endometriosis. Material and methods:We conducted a population-based cohort study including women aged 18-50 years undergoing same-day or inpatient surgery for endometriosis from 1 April 2002 through 31 March 2018. Surgery was classified as minimally invasive hysterectomy (MIH), total abdominal hysterectomy (TAH) or minor or major conservative (uterus-preserving) surgery. Outcomes examined included length of stay, intraoperative complications, postoperative complications, emergency department visits, ambulatory care visits, and readmission. We estimated the relative risk of these outcomes in minor, major conservative surgery and TAH vs MIH adjusted for age, income quintile, parity, and comorbidities.Results: A total of 85 605 patients underwent surgery, 12.9% MIH, 22.1% TAH, 36.3% major conservative, and 28.6% minor conservative. The mean age at index surgery was 37.6 ± 7.7 years. Before surgery, 70.6% of patients had visited a physician for pain at least once (64.7% MIH, 69.5% TAH, 71.1% major conservative and 73.4% minor conservative) and 23.5% of patients had sought infertility consultation (5.7% MIH, 6.6% TAH, 29.3% major conservative and 37.1% minor conservative). The overall risk of intraoperative and postoperative complications was 1.5% and 4.7%, respectively.In adjusted models, compared with those undergoing minor conservative surgery, those having major conservative surgery were 1.77 (95% CI 1.49-2.11) times as likely to experience an intraoperative complication, those having MIH and TAH were 2.55 (95% CI 2.08-3.13) and 2.34 (95% CI 1.93-2.82) times as likely to do so, respectively.Similarly, compared with those undergoing minor conservative surgery, those having major conservative surgery were 2.60 (95% CI 2.30, 2.93) times as likely to experience any postoperative complication, and those having MIH and TAH were 4.69 (95% CI 4.11-5.36) and 5.38 (95% CI 4.76-6.09) times as likely to do so, respectively. | 1141 BOUGIE Et al.

Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis

“…Ideally the benefits of hysterectomy over EES alone would be studied in a randomised controlled trial, however this may not be ethically feasible, and may still suffer from selection bias at the enrolment and follow-up stages. Additionally, although greater improvement in pain symptoms surgery, while approximately 20% of patients having conservative EES underwent additional surgery within 5 years of index procedure (Bougie et al, 2021a). These studies and ours demonstrate the utility of hysterectomy with bilateral salpingooophorectomy in effectively treating symptoms, improving quality of life while reducing the need for repeat surgery.…”

Administrative health data sets to study endometriosis: a population-based approach

“…Ideally, patients with deep endometriosis would receive an accurate diagnosis preoperatively through diagnostic imaging 2 and consequently be counseled about their potential surgical outcomes.We draw your attention to our publication that looks at the 30-day postoperative outcomes in this cohort. 3 Here, we examined the outcomes based on the route of hysterectomy and identified that the individuals undergoing abdominal hysterectomy had a longer hospital stay and a higher rate of postoperative visits for pain than those undergoing minimally invasive surgery, which is consistent with the literature on this topic. Given that the main objective of the article in this discussion was to examine the long-term outcomes after endometriosis surgery, including reoperation trends, we felt that the more appropriate comparison groups were based on the extent of surgical intervention rather than the surgical modality.…”

O papel da cirurgia na endometriose

“…Apesar da orientação das diretrizes de prática clínica, a decisão de realizá-la pode ser complexa devido à variabilidade desta condição. As indicações para cirurgia incluem tratamento médico ineficaz, preocupação com malignidade ou otimização da fertilidade (BOUGIE O, et al, 2021).…”

“…Centro Universitário de Patos (UNIFIP), Patos -PB 2. Universidade do Estado do Ceará (UECE), Fortaleza -CE 3. Faculdade São Francisco da Paraíba, Cajazeiras -PB.SUBMETIDO EM: 11/2022 | ACEITO EM: 12/2022 | PUBLICADO EM: 1/2023…”