Department of Obstetrics and Gynecology, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada.
ICES Queen's, Kingston, ON, Canada.
Acta Obstet Gynecol Scand. 2021 Jun;100(6):1140-1147. doi: 10.1111/aogs.14071. Epub 2021 Jan 23.
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.
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.
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.
Approximately one-third of patients undergoing surgical management for endometriosis in Ontario between 2002 and 2018 had a hysterectomy. Overall, complications following surgery were low, and dependent on extent of surgery. These results should help to inform preoperative counseling for patients and health policy development for providers.
我们的目的是比较加拿大安大略省不同手术方式治疗子宫内膜异位症的短期结局，并对接受子宫内膜异位症手术治疗的患者人群进行特征描述。
我们进行了一项基于人群的队列研究，纳入了 2002 年 4 月 1 日至 2018 年 3 月 31 日期间因子宫内膜异位症接受日间或住院手术的 18-50 岁女性。手术分为微创子宫切除术（MIH）、全子宫切除术（TAH）或小或大的保守性（保留子宫）手术。检查的结局包括住院时间、术中并发症、术后并发症、急诊就诊、门诊就诊和再入院。我们根据年龄、收入五分位数、产次和合并症，调整了 MIH、大保守性手术和 TAH 与小保守性手术相比的这些结局的相对风险。
共有 85605 名患者接受了手术，12.9%的患者接受了 MIH，22.1%的患者接受了 TAH，36.3%的患者接受了大保守性手术，28.6%的患者接受了小保守性手术。指数手术时的平均年龄为 37.6±7.7 岁。手术前，70.6%的患者至少因疼痛就诊过一次（64.7%的 MIH，69.5%的 TAH，71.1%的大保守性手术和 73.4%的小保守性手术），23.5%的患者寻求过不孕咨询（5.7%的 MIH，6.6%的 TAH，29.3%的大保守性手术和 37.1%的小保守性手术）。术中并发症和术后并发症的总体风险分别为 1.5%和 4.7%。在调整后的模型中，与接受小保守性手术的患者相比，接受大保守性手术的患者发生术中并发症的风险增加 1.77 倍（95%CI 1.49-2.11），接受 MIH 和 TAH 的患者发生术中并发症的风险分别增加 2.55 倍（95%CI 2.08-3.13）和 2.34 倍（95%CI 1.93-2.82）。同样，与接受小保守性手术的患者相比，接受大保守性手术的患者发生任何术后并发症的风险增加 2.60 倍（95%CI 2.30-2.93），接受 MIH 和 TAH 的患者发生任何术后并发症的风险分别增加 4.69 倍（95%CI 4.11-5.36）和 5.38 倍（95%CI 4.76-6.09）。
2002 年至 2018 年期间，安大略省约三分之一接受子宫内膜异位症手术治疗的患者接受了子宫切除术。总的来说，手术后的并发症较低，且取决于手术的范围。这些结果应该有助于为患者提供术前咨询，并为提供者制定医疗政策。
