Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement

Abstract

Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement Clothilde Poupona, Clémentine Owena,*, Alexandra Arfia, Jonathan Cohena, Sofiane Bendifallaha,b,c, Emile Daraïa,b,c a Department of Gynecology and Obstetrics, Tenon Hospital, AP-HP, Sorbonne University, France b GRC 6 -UPMC : Centre Expert En Endométriose (C3E), Sorbonne University, France c UMR-S 938, France A R T I C L E I N F O Article history: Received 2 December 2018 Received in revised form 10 April 2019 Accepted 20 April 2019 Available online 2 May 2019 Keywords: ASRM classification Clavien Dindo classification Deep endometriosis Enzian classification Postoperative complication A B S T R A C T Study Objective: To describe complications following surgery for deep endometriosis (DE) without bowel involvement and to develop a nomogram for predicting postoperative complications. Design: Retrospective study Setting: Tertiary referral university hospital and expert center in endometriosis Patients: Two-hundred and twenty patients with DE without bowel involvement Interventions: Laparoscopic resection for DE without bowel involvement Measurements and Main Results: Operative complications were evaluated using the Clavien-Dindo classification. Voiding dysfunction was defined as a need for bladder self-catheterization lasting >1 month. Fifty-three patients (24%) had postoperative complications: 31 (14%) had a Clavien-Dindo grade I II complication (3 grade I and 28 grade II); 11 (5%) had a grade III complication (2 grade IIIa and 9 grade IIIb); and 11 (5%) had voiding dysfunction. No grade IV V complications were observed. Age, Enzian classification risk group, and previous surgery for endometriosis were significantly associated with postoperative complications. The predictive model had an AUC of 0.72 (95% CI, 0.70–0.74) before and 0.70 (95% CI, 0.68–72) after bootstrap sample correction. The average difference and maximal difference in predicted and calibrated probabilities of recurrence were 0.023 and 0.089% respectively Conclusion: Surgery for DE without bowel resection is associated with a relatively high incidence of voiding dysfunction and postoperative complications mainly corresponding to Clavien-Dindo grade I II. Age, risk group of Enzian classification, and previous surgery for endometriosis are significantly associated with postoperative complications and voiding dysfunction. Our results allowed us to build a nomogram which can be used to better inform patients about the risk of DE surgery without bowel involvement