Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors

Objective: To determine perioperative outcomes and factors impacting operating time, length of hospital stay, and complications of patients undergoing surgery for stage 3 or 4 endometriosis. Design: Retrospective review of medical records (Canadian Task Force classification II-2). Setting: Mayo Clinic Hospital, Phoenix, Arizona. Patients: Women (n = 493) with endometriosis stage 3 and 4 undergoing surgical excision between March 15, 2005, and December 31, 2011. Interventions: Robotic-assisted (n = 331) or laparoscopic (n = 162) excision. Measurements: Age, body mass index, comorbidities, number and type of procedures per patient, type of surgical approach, operating time, blood loss, intraoperative and postoperative complications (within 42 days), and length of hospital stay. Main Results: The mean patient age was 39.5 years; body mass index, 25.9; number of procedures, 3.3; operating time, 130.4 minutes; blood loss, 88.5 mL; and hospital stay, 1.0 days. Major complications occurred in 5 patients (1.5%). Fifty-nine patients (12.0%) underwent modified radical hysterectomy, 90 (18.3%) underwent ureteral and/or intestinal resection, and 3 (0.6%) underwent diaphragm resection. Factors significantly associated with operating time included age (p =.008) and blood loss, number of procedures per patient, and robotics (all p <.001). Length of stay was affected by age, operating time, and blood loss (all p <.001). Operating time was the only significant factor associated with postoperative complications (p <.001). Conclusion: Operating time is an independent and significant factor for postoperative complications and hospital stay.