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Presence of endometriosis is commonly believed to make surgery more complex; however, there is a paucity of data to support and elaborate upon this idea. We aim to describe the incidence of endometriosis among patients undergoing total laparoscopic hysterectomy (TLH), as well as the impact of endometriosis on surgical complications and reimbursement. Retrospective cohort. 147 academic or community-based hospitals in the United States participating in the American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing TLH for benign indications from 2014 to 2017. Presence or absence of endometriosis was determined by chart and operative note review by trained research assistants, rather than reliance on diagnosis codes. A total 29,243 TLH's were identified. Endometriosis was noted in 16.5% of all patients undergoing TLH for benign indications. Though more prevalent among white patients, endometriosis is common among black patients undergoing TLH (16.7% white versus 12.8% black, p<0.001). Only 10.5% of patients with endometriosis documented at the time of hysterectomy underwent concomitant excision or ablation of endometriosis. Perioperative complications were more common among patients with endometriosis (5.1% versus 4.4%, p=0.04). Hysterectomies in patients with endometriosis noted intraoperatively earned a lower average number of work relative value units (wRVU's) compared to hysterectomies in patients without endometriosis (16.1 versus 16.3, p<0.001). Endometriosis is a common finding at the time of benign TLH; however, peritoneal endometriosis is rarely treated at the time of hysterectomy. Though patients with endometriosis are more likely to have surgical complications, their surgeries earn fewer wRVU's than surgeries in patients without endometriosis. Given its prevalence, endometriosis should be well-understood by all practicing benign gynecologic surgeons. [ABSTRACT FROM AUTHOR]

There is paucity of data and lack of expert consensus on the role of appendectomy in surgical treatment of endometriosis. We seek to describe the nationwide practice of appendectomy for endometriosis, and analyze its safety profile and surgical outcomes. Retrospective cohort. Comparisons were made using Chi-squared for proportions or t-test for means. 708 United States hospitals in the participating in American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing any surgery for endometriosis 2014-2017. Surgeries performed for endometriosis were identified by ICD-9/10 diagnosis code. Utilization of appendectomy was determined by querying these endometriosis surgeries for the CPT procedure codes for appendectomy. We identified 14,776 endometriosis surgeries. Appendectomy was performed in 545 (3.7%) of all surgeries for endometriosis; of these, 352 (64.6%) were performed by gynecologists and 193 (35.4%) by general surgeons. Overall risk of perioperative complications in surgery for endometriosis did not differ with utilization of appendectomy (5.0% appendectomy vs 4.6% no appendectomy, p = 0.67); moreover, the incidence of complications with appendectomy did not differ by surgeon type (5.4% gynecologist vs 4.9% general surgeon, p = 1.0). Utilization of appendectomy was associated with increased operative time (149.0 ± 105.0 vs 117.6 ± 67.7 minutes, p = <0.001) and length of stay (1.9 ± 2.5 vs 1.3 ± 2.2 days, p = <0.001), but lower average work relative value unit (wRVU) compared to endometriosis surgery without appendectomy (14.5 ± 6.5 vs 15.5 ± 4.0, p = <0.001). Appendectomy for endometriosis is rarely performed; when utilized, it is performed by both gynecologists and general surgeons. Utilization of was not associated with differences in overall in risk profile. However, appendectomy for endometriosis was associated with longer operative times and length of stay, and lower reimbursement. [ABSTRACT FROM AUTHOR]

To assess Fundamentals of Laparoscopic Surgery (FLS) exam scores among OBGYN and general surgery providers. This is a descriptive study of all FLS examinees in OBGYN and general surgery and at a single academic institution (Beth Israel Deaconess Medical Center [BIDMC], Boston, MA) from July 2007 to May 2018. We compared categorical and continuous variables with Chi-square, t, and Wilcoxon rank-sum tests. N/A N/A N/A 205 BIDMC trainees and faculty took the FLS exam between July 2007 and May 2018 of which 176 were identified to be OBGYN or general surgery providers. The FLS pass rate was high for both specialties (98.7% OBGYN, 99.0% surgery, p= 0.42). When comparing providers in OBGYN and general surgery, no difference was found in manual skills score (mean 594.9 OBGYN vs 601.0 surgery, p=0.59), however, a significant difference was noted in the cognitive scores with surgery providers scoring higher than OBGYN providers (mean 533.8 OBGYN vs 583.4 surgery, p=0.0003). In a multivariate linear regression model adjusting for specialty, level of training, age, sex, and test year, none of the variables were significant predictors for manual scores. However, age, sex, and test year were predictors for cognitive scores with greater scores associated with younger age, male sex, and advancing calendar year. Surgical specialty was not a predictor for manual or cognitive scores. Overall, both OBGYN and surgery residents had a high FLS pass rate. The manual skills test scores were comparable between specialties, but the cognitive scores were lower for OBGYN compared to surgery providers. Further investigation regarding validity of the cognitive component of the FLS exam for OBGYN providers may be warranted. [ABSTRACT FROM AUTHOR]