Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study.

Autor: Hudelist G; Department of Gynecology, Center for Endometriosis, Hospital St. John of God; Rudolfinerhaus Private Clinic and Campus, Vienna, Austria., Korell M; Department of Obstetrics and Gynecology, Johanna-Etienne-Hospital, Neuss, Germany., Burkhardt M; Department of Obstetrics and Gynecology, Medius Klinik Ostfildern, Ostfildern, Germany., Chvatal R; Department of Obstetrics and Gynecology, Znojmo District Hospital, Znojmo, Czech Republic., Darici E; Brussels IVF, Center for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium., Dimitrova D; Department of Obstetrics and Gynecology with Center for Oncological Surgery, Charité - Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany., Drahonovsky J; Department of Obstetrics and Department of Gynecology, University of Prague, Prague, Czech Republic., Haj Hamoud B; Department of Obstetrics and Gynecology, University Saarland, Homburg, Germany., Hornung D; Department of Obstetrics and Gynecology, Vidiakliniken, Diakonissen Hospital Karlsruhe, Karlsruhe, Germany., Krämer B; Department of Obstetrics and Department of Gynecology, University of Tübingen, Tübingen, Germany., Noe G; Department of Obstetrics and Department of Gynecology, Rhineland Clinic, Dormagen, Germany., Oppelt P; Department of Gynecology and Obstetrics, Kepler Medical University of Linz, Linz, Austria., Schäfer SD; Department of Gynecology and Obsterics, Medical University Hospital Münster, Münster, Germany., Seeber B; Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria., Ulrich UA; Department of Obstetrics and Gynecology, Martin Luther Hospital Berlin, Berlin, Germany., Wenzl R; Department of Gynecology and Obsterics, Medical University of Vienna, Vienna, Austria., De Wilde RL; Department of Gynecology and Obstetrics, Pius Hospital, Universitätsmedizin Oldenburg, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany., Wimberger P; Department of Obstetrics and Gynecology, Technical University Dresden, Dresden, Germany., Senft B; Statistix Institute, Klagenfurt, Austria., Keckstein J; Gynecological Practice, Drs Keckstein, Villach, Austria., Montanari E; Department of Gynecology, Center for Endometriosis, Hospital St. John of God; Rudolfinerhaus Private Clinic and Campus, Vienna, Austria., Vaineau C; Department of Gynecology and Obsterics, Medical University of Bern, Inselspital, Bern, Switzerland., Sillem M; Department of Obstetrics and Gynecology, University Saarland, Homburg, Germany.; Praxisklinik am Rosengarten, Mannheim, Germany.
Jazyk: angličtina
Zdroj: Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2022 Oct; Vol. 101 (10), pp. 1057-1064. Date of Electronic Publication: 2022 Jul 12.
DOI: 10.1111/aogs.14418
Abstrakt: Introduction: Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries.
Material and Methods: This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared.
Results: The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (r Spearman  = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups.
Conclusions: A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.
(© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
Databáze: MEDLINE
Externí odkaz: