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Abstract

Introduction:

To evaluate differences in surgical outcomes of minimally invasive hysterectomy performed for endometriosis between general gynecologists and gynecologic oncologists.

Methods:

Utilizing the 2016–2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hysterectomy dataset, we evaluated baseline characteristics and surgical outcomes for patients who underwent a minimally invasive hysterectomy for endometriosis between general gynecology and gynecologic oncology groups.

Results:

From 2016 to 2018, a total of 3751 minimally invasive hysterectomies were performed for the primary diagnosis of endometriosis. Of these cases, 3129 (83.4%) were performed by general gynecologists and 622 (16.6%) by gynecologic oncologists. There were several differences in baseline characteristics between the groups. Notably, general gynecologists performed a higher proportion of vaginal hysterectomies (7.9% vs 0.6%, p < 0.01).

There were no statistically significant differences in overall 30-day complications or mortality between general gynecology and oncology groups, with the exception of a higher rate of postoperative sepsis (0.8% vs 0.2%, p = 0.01) in hysterectomies performed by oncologists. Compared to general gynecologists, oncologists had a longer operative time (134.9 ± 65.4 min vs 129 ± 60.9 min, p = 0.05). Multivariate regression of multiple tracked and composite outcomes revealed no consistent confounding variables other than race. In fact, African American race was a statistically significant predictive factor of composite complications (OR 1.80, p < 0.01), morbidity (OR 1.84, p < 0.05), and unplanned readmission (OR 2.30, p < 0.01). Surgeon specialty was not associated with composite complications, hysterectomy-specific complications, or readmission.

Conclusion:

There are no significant differences in surgical outcomes for minimally invasive hysterectomy for endometriosis between these two surgical subspecialties.

Keywords

Gynecologist endometriosis gynecologic oncologist laparoscopic hysterectomy laparoscopy NSQIP surgical complications surgical outcomes

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Minimally invasive hysterectomy for endometriosis: Surgical outcomes based on surgeon specialty