Surgical Treatment of Patients with Endometriosis in the Certified Endometriosis Centers of the DACH Region - A Subanalysis of the Quality Assurance Study QS ENDO pilot

Abstract

Introduction After puberty, at least 10% of all women and girls suffer from endometriosis. Surgery is useful for both the diagnosis and therapy. To date, quality indicators for the surgical treatment of endometriosis are lacking. QS ENDO aims to record the quality of care provided in the DACH region and to introduce quality indicators for the diagnosis and treatment of endometriosis. In the first phase of the study, QS ENDO real, the reality of care was recorded using a questionnaire. The second phase, QS ENDO pilot, investigated the treatment of patients who underwent surgery in certified endometriosis centers in a defined time-period. Material and Methods The surgical data of 10 patients from each of the 44 endometriosis centers in the DACH region was recorded using an online tool. Collected data included the approach used, the endometriosis phenotype, a description of the surgical site, resection status, histological confirmation, the use of a classification, and any complications. All operations were carried out in October 2016 as the defined time-period. The surgical approaches used were compared with the recommendations in the current guidelines. Results The data of 435 patients with a median age of 34 years were evaluated. 315 (72.4%) were nulliparous. 120 patients had given birth to at least one child and 42.5% (51) of them had delivered their child by caesarean section. About 50% of all patients also had deep infiltrating endometriosis in addition to ovarian endometriosis, and the median NAS score was 7.5. With regards to the surgical treatment, endometriomas were completely resected in 81% (94) of patients. 87.3% of patients underwent resection of peritoneal endometriosis. Forty-one patients had a hysterectomy, with a total hysterectomy carried out in 26 (63.4%) and a supracervical hysterectomy in 15 (36.6%) patients. Of the 59 patients with bowel endometriosis, half had segmental resection and half had shaving of the anterior rectal wall. Complications requiring revision occurred in 0.9% of cases. Conclusion The surgical procedures carried out in the certified endometriosis centers of the DACH region are largely in line with the recommendations for appropriate surgical approaches in the current standard guidelines.

Keywords: care research; endometriosis centers; quality indicators; quality of care; reality of care; surgery.

Fig. 1

Representation of the data query in the online documentation system.

Fig. 2

Caesarean section rate in percent for the cohort of patients with endometriosis (42.5%) compared to the rates for the different DACH countries (Germany, Austria, Switzerland [29.8 – 32.6%]). 120 patients with endometriosis had given birth, D – Germany, A – Austria, CH – Switzerland (adapted from ,  15 ).

Fig. 3

Box plot showing subjective pain (mean NAS values) according to endometriosis type (solid line: median, x: average) with minimum and maximum values (including outliers for endometrioma and DIE). NAS information was available for 187 patients; 1 = little pain, 10 = strongest pain. NAS = numerical analog scale, DIE = deep infiltrating endometriosis.

Fig. 4

Incidence of combined types of endometriosis for ovarian ( a ), peritoneal ( b ) and deep infiltrating endometriosis ( c ). Probability in percent of isolated or combined occurrence of different endometriosis types.

Abb. 1

Beispielhafte Darstellung der Abfrage im Online-Dokumentationssystem.

Abb. 2

Sectiorate in Prozent im Kollektiv der Patientinnen mit Endometriose (42,5%) im Vergleich zur jeweiligen Rate in den DACH-Regionen (Deutschland, Österreich, Schweiz [29,8 – 32,6%]). n = 120 Patientinnen mit Endometriose und vorangegangener Geburt, D – Deutschland, A – Österreich, CH – Schweiz (adaptiert nach ,  15 ).

Abb. 3

Subjektives Schmerzempfinden (NAS) nach Endometrioseart als durchschnittlicher NAS Wert (durchgezogene Linie: Median, x: Mittelwert) als Boxplot mit Darstellung von Minimum und Maximum (inkl. Ausreißer bei Endometriom und TIE). n = 187, alle Patientinnen mit Angabe zur NAS, 1 = wenig Schmerzen, 10 = stärkste Schmerzen. NAS = numerische Analogskala, TIE = tief-infiltrierende Endometriose.

Abb. 4

Häufigkeit kombiniert auftretender Endometrioseformen bei ovarieller ( a ), peritonealer ( b ) und tief-infiltrierender Endometriose ( c ). Prozentuale Wahrscheinlichkeit des isolierten oder kombinierten Auftretens der jeweiligen Endometrioseform.