Effects of centralized multidisciplinary surgical endometriosis care: a retrospective 3-year follow-up cohort study

Koivurova S, Sari Koivurova, Makelä-Kaikkonen J, Johanna Makelä-Kaikkonen, Johanna Laru, Laru J, Pasi Ohtonen, Ohtonen P, Uimari O, Outi Uimari, Niinimäki M, Maarit Niinimäki, Rautio T, Tero Rautio, Terho A, Anna Terho
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04558-0 · PMID:42177522 · PMC13383550 · W7162205056
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Centralization of endometriosis surgery increased referrals, multidisciplinary team involvement, and hormonal treatment, leading to improved preoperative diagnosis and postoperative surveillance.

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Abstract

BACKGROUND: We aimed to study the impact of centralizing surgical endometriosis care, including possible improvements in patient outcome. METHODS: This study is a single tertiary centre retrospective cohort study with a 3-year postoperative follow-up conducted at the University hospital district of Oulu, Finland. The cohorts consisted of 215 women operated before centralization (January 2013 - June 2016) and 246 women operated after centralization (July 2016 - December 2019). Background, intraoperative and postoperative 3-year data were collected from hospital records. NRS and EHP-30 questionnaires were sent to patients to study long-term patient outcome. Comparisons were made between the two time periods. Main outcome measures were rates of referrals from secondary to tertiary level hospital, changes in diagnostics, implementation of multidisciplinary approach and patient access to specialized endometriosis care. Data were analysed via SPSS version 28.0 using independent samples t-test or Mann-Whitney U-test and Chi-squared test or Fisher's exact test. Multivariable adjusted models were used to control for possible confounding factors when comparing the two time periods. RESULTS: After centralization, referrals from secondary level hospitals tripled (4.6% vs. 12.6%, p = 0.003). Preoperative endometriosis diagnosis using MRI increased (24.2% vs. 48.8%, p < 0.001) and complex surgery was more often planned and performed by a multidisciplinary team (3.3% vs. 18.3%, p < 0.001; 8.8% vs. 18.4%, p = 0.008). A slight non-significant reduction in complication risk was detected after centralization (aOR 0.95, 95% CI 0.50-1.78). Hormonal treatment was more common pre- and postoperatively (35.8% vs. 52.7%, p = 0.002; 47.9% vs. 69.9%, p < 0.001). Postoperative follow-up at tertiary level hospital was longer (8.2 mo vs. 12.2 mo, p = 0.002). CONCLUSIONS: Centralization of endometriosis surgery was achieved in terms of increased number of referrals. Multidisciplinary approach was implemented more often in diagnostics, preoperative counselling and surgery. Preoperative and postoperative hormonal treatments were conducted more thoroughly. Postoperative specialized care surveillance was increased after centralization allowing chronically symptomatic patients a better access to an individualized treatment plan.
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Abstract

Background We aimed to study the impact of centralizing surgical endometriosis care, including possible improvements in patient outcome.

Methods

This study is a single tertiary centre retrospective cohort study with a 3-year postoperative follow-up conducted at the University hospital district of Oulu, Finland. The cohorts consisted of 215 women operated before centralization (January 2013 – June 2016) and 246 women operated after centralization (July 2016 – December 2019). Background, intraoperative and postoperative 3-year data were collected from hospital records. NRS and EHP-30 questionnaires were sent to patients to study long-term patient outcome. Comparisons were made between the two time periods. Main outcome measures were rates of referrals from secondary to tertiary level hospital, changes in diagnostics, implementation of multidisciplinary approach and patient access to specialized endometriosis care. Data were analysed via SPSS version 28.0 using independent samples t-test or Mann-Whitney U-test and Chi-squared test or Fisher’s exact test. Multivariable adjusted models were used to control for possible confounding factors when comparing the two time periods.

Results

After centralization, referrals from secondary level hospitals tripled (4.6% vs. 12.6%, p = 0.003). Preoperative endometriosis diagnosis using MRI increased (24.2% vs. 48.8%, p < 0.001) and complex surgery was more often planned and performed by a multidisciplinary team (3.3% vs. 18.3%, p < 0.001; 8.8% vs. 18.4%, p = 0.008). A slight non-significant reduction in complication risk was detected after centralization (aOR 0.95, 95% CI 0.50–1.78). Hormonal treatment was more common pre- and postoperatively (35.8% vs. 52.7%, p = 0.002; 47.9% vs. 69.9%, p < 0.001). Postoperative follow-up at tertiary level hospital was longer (8.2 mo vs. 12.2 mo, p = 0.002).

Conclusions

Centralization of endometriosis surgery was achieved in terms of increased number of referrals. Multidisciplinary approach was implemented more often in diagnostics, preoperative counselling and surgery. Preoperative and postoperative hormonal treatments were conducted more thoroughly. Postoperative specialized care surveillance was increased after centralization allowing chronically symptomatic patients a better access to an individualized treatment plan. Similar content being viewed by others Abbreviations - ASA: - American Society of Anaesthesiology - BMI: - Body mass index - DE: - Deep endometriosis - EHP-30: - Endometriosis-related Health Profile - MDT: - Multidisciplinary team - MRI: - Magnetic resonance imaging - NRS: - Numeric rating scale - OUH: - Oulu University Hospital - TVS: - Transvaginal sonography - QoL: - Quality of life

Acknowledgements

We wish to express our gratitude to the patients who answered our mail questionnaires, as well as our dedicated endometriosis nurses Anne Parviainen and Hanna-Mari Pyrrö. Funding Open Access funding provided by University of Oulu (including Oulu University Hospital). This study was funded by the Finnish State Research Grant 2023. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate As the study was mainly based on retrospective hospital register-based data, no consents of participation in addition to ethics committee approval were needed. Regarding NRS and EHP-30 questionnaires, all patients were sent an informed consent form by mail and those responding to the questionnaires with a signed consent form were included in the analyses. Competing interests Prof. Tero Rautio is a surgical consultant for Intuitive Surgical, Inc. Ethics statement This study was approved by the regional medical research ethics committee of the Wellbeing services county of North Ostrobothnia, date 14th July 2020, ref 179/2020. The study adhered to the Declaration of Helsinki criteria. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Koivurova, S., Makelä-Kaikkonen, J., Laru, J. et al. Effects of centralized multidisciplinary surgical endometriosis care: a retrospective 3-year follow-up cohort study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04558-0 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04558-0

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Outcome instruments

EHP-30

Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Patient Care Team Patient Care Team Patient Care Team Patient Care Team Patient Care Team Patient Care Team Patient Care Team

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