Sofiane Bendifallah1,2,3, Horace Roman4,5, Chrystel Rubod6,7, Pierre Leguevaque8, Antoine Watrelot9, Nicolas Bourdel10,11, Marcos Ballester12,13,14, Emile Darai12,13,14. 1. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France. sofiane.bendifallah@aphp.fr. 2. GRC6-UPMC : Centre Expert En Endométriose (C3E), Paris, France. sofiane.bendifallah@aphp.fr. 3. UMR_S938 Université Pierre et Marie Curie, Paris 6, France. sofiane.bendifallah@aphp.fr. 4. Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031, Rouen, France. 5. Research Group EA 4308 'Spermatogenesis and Male Gamete Quality', IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. 6. Department of Gynecology and Obstetrics, CHU Lille, 59000, Lille, France. 7. Faculty of medicine Henri Warembourg, Lille University, 59000, Lille, France. 8. Service de Chirurgie Générale et Gynécologique, Centre Hospitalier et Universitaire Rangueil, Avenue Jean Poulhes, 31000, Toulouse, France. 9. Hôpital NATECIA, 22 Avenue Rockefeller, 69008, Lyon, France. 10. Department of Gynecological Surgery, CHU Estaing Clermont Ferrand, 1 Place Lucie Aubrac, 63000, Clermont-Ferrand, France. 11. ALCoV-ISIT, UMR6284 CNRS, University of Auvergne, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France. 12. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France. 13. GRC6-UPMC : Centre Expert En Endométriose (C3E), Paris, France. 14. UMR_S938 Université Pierre et Marie Curie, Paris 6, France.
Abstract
National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). METHODS: We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach. RESULTS: The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III-V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p < 0.001) was defined. The OCO per surgeon and per year varied between seven (p = 0.007) and 13 procedures (p = 0.03). In a multivariate analysis, we found that only the volume of activity was independently correlated to complication outcomes (p = 0.0013). CONCLUSION: Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis.
National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). METHODS: We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach. RESULTS: The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III-V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p < 0.001) was defined. The OCO per surgeon and per year varied between seven (p = 0.007) and 13 procedures (p = 0.03). In a multivariate analysis, we found that only the volume of activity was independently correlated to complication outcomes (p = 0.0013). CONCLUSION: Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis.
Entities:
Keywords:
Colorectal endometriosis; Endometriosis; Expert center; Morbidity; Surgery
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