Purpose

We aimed to describe the incidence and identify risk factors for the occurrence of short-term major posto-perative complications following colorectal resection for endometriosis.

Methods

A cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012–2020. We included patients with a primary diagnosis of endometriosis who underwent colon or rectal resections for endometriosis.

Results

Of 755 women who underwent colorectal resection, 495 (65.6%) had laparoscopic surgery and 260 (34.4%) had open surgery. The major complication rate was 13.5% (n = 102). Women who underwent open surgery had a higher proportion of major complications (n = 53, 20.4% vs. n = 49, 9.9%, p < 0.001). In a multivariable regression analysis, Black race (aOR 95%CI 2.81 (1.60–4.92), p < 0.001), Hispanic ethnicity (aOR 95%CI 3.02 (1.42–6.43), p = 0.004), hypertension (aOR 95%CI 1.89 (1.08–3.30), p = 0.025), laparotomy (aOR 95%CI 1.64 (1.03–3.30), p = 0.025), concomitant enterotomy (aOR 95%CI 3.02 (1.26–7.21), p = 0.013), and hysterectomy (aOR 95%CI 2.59 (1.62–4.15), p < 0.001) were independently associated with major post-operative complications. In a subanalysis of laparoscopies only, Hispanic ethnicity, chronic hypertension, lysis of bowel adhesions, and hysterectomy were independently associated with major complications. In a subanalysis of laparotomies only, Black race and hysterectomy were independently positively associated with the occurrence of major complications.

Conclusion

This study provides a current population-based estimate of short-term complications after surgery for colorectal endometriosis in the USA. The identified risk factors for complications can assist during preoperative shared decision-making and informed consent process.

中文翻译：

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美国子宫内膜异位症结直肠切除术后主要并发症的危险因素

目的

我们的目的是描述子宫内膜异位症结直肠切除术后短期主要术后并发症的发生率并确定其危险因素。

方法

一项队列研究使用了 2012 年至 2020 年美国外科医生学会国家手术质量改进计划 (NSQIP) 数据库的数据。我们纳入了初步诊断为子宫内膜异位症并因子宫内膜异位症接受结肠或直肠切除术的患者。

结果

在 755 名接受结直肠切除术的女性中，495 名（65.6%）接受腹腔镜手术，260 名（34.4%）接受开腹手术。主要并发症发生率为 13.5% ( n  = 102)。接受开放手术的女性发生主要并发症的比例较高（n  = 53, 20.4% vs. n  = 49, 9.9%, p  < 0.001）。在多变量回归分析中，黑人种族 (aOR 95%CI 2.81 (1.60–4.92)，p  < 0.001)、西班牙裔 (aOR 95%CI 3.02 (1.42–6.43)，p  = 0.004)、高血压 (aOR 95%CI 1.89 (1.08–3.30), p  = 0.025)，剖腹手术 (aOR 95%CI 1.64 (1.03–3.30)，p = 0.025  )，同时进行肠切开术 (aOR 95%CI 3.02 (1.26–7.21)，p  = 0.013)，以及子宫切除术（aOR 95%CI 2.59（1.62-4.15），p  < 0.001）与主要术后并发症独立相关。仅在腹腔镜检查的亚分析中，西班牙裔、慢性高血压、肠粘连松解术和子宫切除术与主要并发症独立相关。在仅剖腹手术的亚分析中，黑人种族和子宫切除术与主要并发症的发生独立呈正相关。

结论

这项研究提供了美国结直肠子宫内膜异位症手术后短期并发症的当前基于人群的估计。已确定的并发症风险因素可以在术前共同决策和知情同意过程中提供帮助。