Effects of centralized multidisciplinary surgical endometriosis care: a retrospective 3-year follow-up cohort study
Sari Koivurova1, Johanna Makelä-Kaikkonen2, Johanna Laru1
1Department of Obstetrics and Gynaecology, Northern Ostrobothnia Wellbeing Services County and Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
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.
