Obstetric and gynecological surgical procedures, and surgical site infections as risk for the development of endometriosis: a multicenter study

Abstract

Aim: Aim this study was to evaluate the incidence of endometriosis in women with a recent history of surgical site infections (SSIs), and obstetric and gynecological surgical procedures. Materials and Methods: A retrospective multicenter cohort was conducted on patients who have had obstetric or gynecological surgical procedures performed from January 2022 to December 2024 in 16 hospitals from six Ukrainian regions. Definitions of SSIs were adapted from the Centers for Disease Control and Prevention’s National Healthcare Safety Network. The criteria for endometriosis were adapted from the ESHRE endometriosis guideline. Results: The study included 33,126 reproductive women with endometriosis who had 16,724 obstetric and 32,383 gynecologic surgical procedures. The incidence of endometriosis in women with history of obstetric and gynecologic surgical procedures, and SSIs was 25.5% [95% confidence interval (CI), 24.3–26.4], 33.3% (95% CI, 33.0–33.6), and 22,1% (20.8–24.2), respectively. Multivariate analysis identified SSIs, obstetric and gynecological surgical procedures as three factors positively associated with the risk of endometriosis. Factors that increased the odds of endometriosis was SSIs (adjusted odds ratio [AOR], 3.76; 95% CI, 2.29–6.20), and obstetric and gynecological surgical procedures (AOR, 7.91; 95% CI, 3.68–37.3). An SSIs and obstetric and gynecological surgery history increased the odds of an endometriosis >7-fold in the cohort (AOR, 7.96; 95% CI, 3.64–37.2). Conclusions: Obstetric and gynecological surgical injury, and the inflammation resulting from SSIs may play a role in developing endometriosis.