To assess the burden of postoperative (postop) complications following surgery for tubal ectopic pregnancy (STEP).METHODS:
Retrospective analysis of 30-day complications following STEP using the National Surgical Quality Improvement Program (NSQIP) database (2005–2013). Complications included wound, UTI, sepsis, venothromboembolism, blood transfusion, extended hospital stay, readmission & reoperation. Multivariable logistic regression assessed relationships of complications to entry route (laparotomy vs laparoscopy) & procedure type (salpingectomy vs salpingostomy); adjusting for race, preoperative (preop) hematocrit, American Society Anesthesiologists (ASA) score, emergency surgery, operating time. Kruskal Wallis test compared median time to postop complications by entry route and procedure type.RESULTS:
594/3041 (19.5%) patients developed complications: higher among laparotomy patients (37.3%) compared to laparoscopy (14.7%), P<.01 & among salpingectomy (20.0%) compared to salpingostomy (17.6%), P=.2. After adjustment: laparotomy was associated with 3-fold increased likelihood of any postop complication compared to laparoscopy (OR=3.0 [95% CI: 2.4–3.8]). Preop hematocrit less than 30% (OR=4.5 [CI: 3.5–5.7]), ASA score (OR=2.0 [CI: 1.5–3.0]) & emergency surgery (OR=1.5 [CI: 1.1–1.9]) increased odds of any complication. Median length of hospital stay differed significantly between entry route via laparotomy & laparoscopy (2 vs 0 day) and also between salpingectomy & salpingostomy (1 vs 0 day), P<.01 for both.CONCLUSION:
∼1 in 5 patients undergoing STEP, developed a postop complication with 3-fold higher likelihood of complication with laparotomy compared to laparoscopy. Preop hematocrit, ASA score & emergency surgery are additional independent predictors of complications. Entry route and procedure type, both influence median length of hospital stay. These findings may guide STEP but warrant prospective investigation.