Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers

Summary of background data 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).

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.

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).

Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis. Similar content being viewed by others

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FRIENDS study group (List of gynecologist and colorectal surgeons who managed the patients enrolled in the study): CHU de Rouen: Pr Horace Roman, Dr Basma Darwish, Dr Julie Ness, Dr Gauthier Dietrich, Dr Benoit Resch, Pr Jean-Jacques Tuech, Dr Emmanuel Huet, Dr Rachid Chati, Dr Julien Coget, Dr Valérie Bridoux; CHU Lille: Dr Chrystèle Rubod, Pr Pierre Collinet, Pr Guillaume Piessen, Dr Thibaut Crombé, Dr Williams Tessier; CHU Toulouse: Pr Pierre Laguevaque; CHU Tenon: Pr Emile Daraï, Pr Marcos Ballester; Hôpital Privé Natécia, Lyon: Dr Antoine Watrelot, Dr Géraldine Chauvin, Dr Jean Sébastien Lanne; CHU Clermont Ferrand: Pr Michel Canis, Dr Nicolas Bourdel, Pr Jean-Luc Pouly, Dr Anne-Sophie Grémeau, Pr Benoit Rabischong, Pr Karem Slim; CHU Nantes: Dr Stéphane Ploteau, Pr Patrice Lopes, Dr Juliette Podevin; Clinique Bouchard, Marseille: Dr Jean Philippe Estrade, Dr Brice Gurriet, Dr Alexandre Lazard, Dr Antoine Camerlo, Dr Xavier Hanna; CHU Cochin: Pr Bertrand Dousset, Pr Charles Chapron, Dr Mahaut Leconte, Pr Bruno Borghese; Polyclinique Santamaria, Nice et Polyclinique Saint-Jean, Cagnes-sur-Mer: Dr Sylvain Tassy, Dr Frédéric de France; CHU de Strasbourg: Pr Arnaud Wattiez, Dr Emilie Faller, Dr Cherif Youssef Akladios, Pr Joël Leroy; GHSJ Paris: Dr Eric Sauvanet, Dr Astrid Mephon, Dr Benjamin Angliviel, Dr Jerome Loriau; CH Versailles: Dr Pierre Panel, Dr Julien Niro, Dr Arnaud Le Toheic; Clinique Millénaire de Montpellier: Pr Herve Dechaud, Dr Dominique Cresienzo; CHU Rennes: Pr Jean Leveque; CHU Besançon: Dr Rajeev Ramanah; Clinique de la Muette, Paris: Pr Patrick Madelenat; CHU de Bordeaux: Pr Hocke Claude, Dr Conri Vanessa, Pr Brun Jean-Luc, Dr Merlot Benjamin, Pr Eric Rullier, Dr Quentin Denost; Réunion Nord: Dr Julie Eggermont, Pr Peter von Theobald, Dr Christophe Duchamp; CHU Lyon Sud: Pr François Golfier; CHU Réunion Sud: Dr Gabriele Marc, Pr Malik Boukerrou; Clinique de la Sagesse, Rennes: Dr Jérôme Blanchot, Dr Jean Vialard; CHU Poissy: Pr Arnaud Fauconnier, Pr Elie Chouillard; CHU Croix Rouge Lyon: Pr Gil Dubernard; CHU Tours: Dr Thomas Hebert; CHU Bichat: Dr Carmen Chis, Dr Martin Koskas; Clinique Mathilde, Rouen: Dr Benoit Resch, Dr Olivier Foulatier, Dr Vianney Roger; CHU Amiens: Dr Sophie Sanguin, Dr Lionel Rebibo, Dr Charles Sabbagh; CHU Dijon: Dr Laurence Filipuzzi; CHU Angers: Pr Philippe Descamps; CHU Montpellier: Dr Claire Vincens; Clinique Sud Vendée, Fontenay le Comte: Dr Eric Hermouet, Dr Hervé Briandet, Dr Marc Guillaume; Polyclinique Kenval, Nîmes: Dr Grégory Triopon; CHU Caen: Dr Mélusine Turck, Pr Raffaèle Fauvet, Dr Thomas Sarcher; CHU Beaujon et Clinique Hartmann, Paris: Pr Nizar Aflak; CHU La Conception, Marseille: Pr Aubert Agostini, Dr Audrey Pivano, Dr Christelle Arbola, Pr Nicolas Pirro, Dr Le Huu Nho Remy; Clinique Brétéché, Nantes: Dr Pascal Guihard, Dr Benoit Dixneuf, Dr Jean-Philippe Arigon; CHU Nancy: Dr Cecile Mezan de Malartic, Pr Olivier Morel, Dr Laurent Bresler; Clinique Clementville Montpellier: Dr Vincent Deutsch; CHU Poitiers: Pr Xavier Fritel, Dr Marie-Line Barussaud; CHU Nîmes: Pr Renaud de Tayrac, Dr Vincent Letouzey, Dr Florent Masia, Pr Michel Prudhomme, Dr Jérémy Ripoche; Clinique de l’Europe, Rouen: Dr Juan Berrocal, Dr Jean Hugues Maillochaud; Clinique du Val d’Ouest, Ecully: Dr Benjamin Cotte, Dr Vincent Schreiber, Dr Philippe Guillem; Clinique du Parc Monceau, Paris: Dr Ludovic Friederich; CHU Kremlin Bicêtre: Pr Hervé Fernandez; CHU Limoges: Dr Tristan Gauthier, Pr Muriel Mathonnet; Clinique Belledonne Grenoble: Dr François Muet; Polyclinique du Parc Rambot, Aix-en-Provence: Dr François Guillibert; CHU Hôpital Privé de l’Estuaire, Le Havre: Dr Jean-François Le Digabel, Dr Philippe Chasserant; CHU Jean Verdier, Bondy: Dr Jeremy Boujenah; CH La Rochelle: Dr Philippe Ferry; CH du Havre: Dr Eric Legoupils; CHU Clamart: Pr Xavier Deffieux; Clinique des Franciscaines, Paris: Dr Deborah Apfelbaum. Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures Authors Sofiane Bendifallah, Horace Roman, Chrystel Rubod, Pierre Leguevaque, Antoine Watrelot, Nicolas Bourdel, Marcos Ballester, Emile Darai have no conflicts of interest or financial ties to disclose. Rights and permissions About this article Cite this article Bendifallah, S., Roman, H., Rubod, C. et al. Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers. Surg Endosc 32, 2003–2011 (2018). https://doi.org/10.1007/s00464-017-5896-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00464-017-5896-z