The Impact of Annual Surgical Volume on Patient Outcomes in Laparoscopic Hysterectomy

Abstract

Abstract

Objective:

An increasing proportion of hysterectomies are performed using a minimally invasive approach due to improved perioperative morbidity and recovery, compared to abdominal hysterectomy. Although metrics to assign competency in laparoscopic hysterectomy (LH) have not been determined, provider volume has been associated with patient outcomes in other surgical procedures. This study's objective was to determine the association of annual surgeon volume of LHs on patient outcomes, including surgical complications within 30 days as well as resource utilization.

Materials and Methods:

A retrospective review of charts of all patients undergoing LHs between July 2011 and March 2014 was conducted in an academic community hospital. Patients were grouped according to the volume of their surgeons. High-volume surgeons were defined as performing >10 LHs per year; intermediate-volume surgeons did 5–10 LHs per year; and low-volume surgeons did <5 LHs per year.

Results:

Forty-six surgeons performed 539 LHs during the study period: 35 surgeons were low-volume; 7 were intermediate-volume; and 4 were high-volume. Surgical volume did not affect the risk of intraoperative or postoperative complications. Low-volume surgeons had higher estimated blood loss, longer operative times, and a trend toward longer hospital stays than other surgeons. Women operated on by low-volume surgeons had a nearly twofold increase in excess resource utilization, compared to women operated on by high-volume surgeons (p = 0.05).

Conclusions:

Annual surgical volume primarily affects patient outcome through higher resource utilization without an impact on surgical complications. (J GYNECOL SURG 34:190)