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Women with ovarian endometriomas may have a higher risk of postoperative complications during cystectomies, according to a retrospective cohort study.

Compared to patients with other benign conditions, those with ovarian endometriomas who underwent a cystectomy were around 20% more likely to have a postoperative complication (adjusted odds ratio [aOR] 1.23, 95% CI 1.18-1.28), reported Megan Orlando, MD, of the Cleveland Clinic in Ohio.

Specifically, cystectomy patients who had ovarian endometriomas were more likely to endure a conversion to laparotomy (5.1% vs 3.1%, P<0.001) or postoperative readmission (8.5% vs 7.1%, P<0.001), she stated in a virtual presentation at the American Association of Gynecologic Laparoscopists (AAGL) annual meeting.

Among those who underwent an oophorectomy, however, there was no significant difference between rates of postoperative complications in patients who had an endometrioma versus other benign conditions (aOR 1.05, 95% CI 0.99-1.12, P=0.08).

The total complication rate among patients with ovarian endometriomas was 13.9% during cystectomy, and 19.4% during oophorectomy.

"Overall, we conclude that this study presents large-scale data regarding complication rates for adnexal surgery for ovarian endometriosis," Orlando said, emphasizing higher complication rates in cystectomy patients. She noted that higher complication rates might be due to more difficult dissection planes at the time of cystectomy for endometriomas, or could be attributed to the presence of other abdominal pelvic disease leading to intraoperative bleeding.

"We believe this data should be included in comprehensive counseling of women with endometriomas considering surgery," Orlando stated.

Endometriosis affects around 10% of reproductive-aged women, she explained, and ovarian endometriomas are the most common manifestation of illness, showing up in 17% to 44% of patients with the disease. Despite the prevalence, outcomes of surgical procedures to treat ovarian endometriomas are poorly described, Orlando stated.

Orlando and colleagues measured perioperative outcomes of premenopausal women with ovarian endometriomas who underwent cystectomies or oophorectomies, comparing them to outcomes associated with other benign neoplasms. The researchers obtained data from Vizient, a healthcare performance improvement company.

They included women, ages 18 to 50, who had a procedure between 2010 and 2020. They measured adverse events that occurred 30 days after a procedure, which included conversion to laparotomy, blood transfusion, ileus, urinary tract injury, bowel injury, readmission, and mortality.

Patients who had a hysterectomy, concomitant obstetric care, gynecologic malignancies, or vaginal surgery were excluded from the analysis.

Orlando's group analyzed around 120,000 patients who a cystectomy, and 53,000 patients who had an oophorectomy. Approximately 28,000 patients in the cystectomy group and 9,000 in the oophorectomy group had ovarian endometriomas.

Patients who underwent an oophorectomy were more likely to be older than those who had a cystectomy. Of all patients included in the study, those diagnosed with ovarian endometriomas were more likely to identify as Asian and less likely to identify as Black or Hispanic. Women with endometriomas were less frequently obese, diagnosed with diabetes, or tobacco users.

Nearly all cystectomy patients underwent a minimally invasive procedure. Although the researchers did not find an increased risk of complication during oophorectomy, oophorectomy patients with ovarian endometriomas were less likely to have a minimally invasive surgery (56% vs 65%), or to undergo an outpatient procedure (34% vs 42%). Orlando said the higher proportion of laparotomies in this cohort reveals an improvement target for endometriosis care.

Orlando also noted that urinary tract injuries were rare among patients with endometriomas, occurring more frequently in patients with other indications.

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