Effect of surgical volume on outcomes for laparoscopic hysterectomy for benign indications

Abstract

Objective: To estimate the influence of surgical volume on outcome and resource utilization for laparoscopic hysterectomy for benign indications.

Methods: Patients who underwent laparoscopic hysterectomy from 2000 to 2010 and recorded in a commercial database were analyzed. Patients were stratified into tertiles according to the number of procedures performed by their surgeons and at their hospital. The influence of surgeon and hospital volume on perioperative morbidity and resource utilization was examined using multivariable regression models.

Results: A total of 124,615 patients were identified. The overall complication rate decreased from 6.2% for low-volume surgeons to 4.2% for high-volume surgeons (P<.001). Patients operated on by high-volume surgeons were 25% (risk ratios [RRs] 0.75, 95% confidence interval [CI] 0.68-0.82) less likely to experience a complication. In multivariable models intraoperative complications, surgical-site complications, medical complications, prolonged hospitalization, and transfusion rates were lower for high-volume surgeons. Overall morbidity was 5.8% for women treated at low-volume hospitals compared with 4.7% at high-volume centers (P<.001). Women treated at high-volume centers were 18% (RR 0.82, 95% CI 0.75-0.90) less likely to experience a complication. Procedure costs for high-volume surgeons were $867 lower than for low-volume surgeons, and treatment at a high-volume center reduced costs by $966 per procedure.

Conclusion: Performance of laparoscopic hysterectomy by high-volume surgeons and at high-volume hospitals is associated with modest reductions in morbidity and lower costs.

Level of evidence: II.