Design: Retrospective cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020.

Patients or Participants: Patients with endometriosis diagnosis.

Interventions: Laparoscopic surgery for endometriosis.

Measurements and Main Results:

We compared women with and without 30-day post-operative major complications, defined according to the Clavien-Dindo classification.

28,697 women underwent minimally invasive surgery during the study period, of which 2.6% had major post-operative complications. Organ space surgical site infection and reoperation were the most common complications (47.0% and 39.8%, respectively).

In multivariable regression analysis, African American race [aOR 95%CI 1.61 (1.29-2.01), p<0.001], hypertension [aOR 95%CI 1.23 (1.02-1.50), p=0.035], bleeding disorders [aOR 95%CI 1.96 (1.03-3.73), p=0.042], bowel procedures [aOR 95%CI 2.03 (1.61-2.56), p<0.001] and hysterectomy [aOR 95%CI 2.12 (1.74-2.57), p<0.001] were independently associated with increased risk of major complications.

In a subanalysis of laparoscopies without bowel procedures, the rate of major complications was 2.5%. In multivariable regression analysis, African American race [aOR 95% CI 1.57 (1.22-2.01), p<0.001], bleeding disorders [aOR 95% CI 2.06 (1.05-4.08), p=0.037] and hysterectomy [aOR 95% CI 1.95 2.76 (2.16-3.53), p<0.001] were associated with increased major complication risk.

Bowel procedures were performed in 2,041 cases, with a major complication rate of 4.3%. In multivariable regression analysis, African American race [aOR 95%CI 1.76 (1.02-3.06), p=0.043], immunosuppressive therapy [aOR 95%CI 3.04 (1.15-8.00), p=0.025] and colectomy [aOR 95%CI 1.96 (1.26-3.06), p=0.003] were associated with increased major complication risk.

Conclusion: Among women undergoing minimally invasive surgery for endometriosis, African American race, hypertension, bleeding disorders and bowel surgery or hysterectomy are risk factors for major complications. African American race is a risk factor for major complications among women undergoing surgeries with and without bowel procedures.