How to identify an Expert Centers for Colorectal Endometriosis Surgery

To be defined as "expert" without increasing the risk of surgery-related complications, a center should perform 20 endometriosis operations per year.

Key Points

Highlights:

• The optimal cut off point to be defined as an expert center is 20 endometriosis operations per year. 

Importance:

• It is of great importance to define expert centers for endometriosis surgery to minimize the risk of surgery-related complications

What’s done here?

• Researchers analyzed 56 hospitals where 1,135 endometriosis operations have been performed during 2015 regarding complications arising as a result of endometriosis surgery.

Key results:

• The average number of operations per surgeon per year was 9.17; Eighty-two (7.6%) of women had grade 3-5 complications following endometriosis surgery.
• Surgery-related complications included rectovaginal fistula (in 31 patients), anastomotic leakage (9 patients), pelvic abscess (39 women), and ureteral fistula (8 women).
• The statistical analysis revealed an optimal cut of point of 20 operations per center per year, and of seven to 13 procedures per surgeon per year to minimize the incidence of endometriosis surgery-related complications.

Limitations of the study:

The research should be repeated in other countries or as an international study to ensure that the defined cut off point is not specific to French hospitals.  

Lay Summary

It is of paramount importance to determine set criteria to define expert centers for colorectal endometriosis surgery, according to a research article published in the scientific journal Surgical Endoscopy. 

As the hospital and surgeon case volume has a significant impact on the development of endometriosis-related complications and defining criteria for expert centers can help better manage colorectal endometriosis. 

Although international guidelines recommend that patients with severe forms of endometriosis are referred to expert centers, there are no clear criteria to define an expert center, according to the authors of the study.

In order to examine the role of surgeons and the volume of hospital procedures on complications related to "Deep Infiltrating Endometriosis of the Rectum and Sigmoid colon (DIERS)", the team led by Dr. Emile Darai at University Pierre and Marie Curie in Paris, France conducted a retrospective multi-center study of French hospital facilities performing colorectal surgery for DIERS. They specifically looked at the relationship between case volume and the incidence of complications related to DIERS.

The analysis included 56 hospitals and 1,135 operations conducted during 2015. The results showed that during that year, the average number of surgeries per surgeon was 9.17. Out of all cases, 82 women had grade 3-5 complications with one patient having a grade 5 complication. The complications included rectovaginal fistula (in 31 women), anastomotic leakage (leakage at the site of surgery, in nine women), pelvic abscess, (the end stage in genital tract infection, in 39 women), and ureteral fistula (in eight women).

Using statistical analysis, the estimated optimal cut of point of 20 operations per center per year, and of seven to 13 operations per surgeon per year to minimize the incidence of endometriosis surgery-related complications but to be still defined as an expert center. 

“Our results contribute to providing objective morbidity data for determining criteria for defining expert centers for colorectal surgery for endometriosis,” the authors concluded.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29067577