Risk factors for major complications following colorectal resections for endometriosis in the USA

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.