Hysterectomy outcomes, surgical volume linked

February 1, 2011

Women undergoing vaginal hysterectomy experience less perioperative morbidity and use fewer resources when high-volume, rather than low-volume, vaginal surgeons perform the procedure, according to a new study.

Women undergoing vaginal hysterectomy experience less perioperative morbidity and use fewer resources when high-volume, rather than low-volume, vaginal surgeons perform the procedure, a study by investigators at Columbia University Medical Center shows. Investigators analyzed data from 500 hospitals throughout the United States for 77,109 patients operated on by 6,195 gynecologic surgeons between 2003 and 2007.

About 2.5% of patients treated by low-volume gynecologic surgeons (ie, those who perform fewer than 5.4 vaginal procedures annually) experienced operative injuries compared with 1.7% of those operated on by high-volume gynecologic surgeons (those who perform more than 54.4 vaginal procedures annually). Put another way, patients operated on by high-volume surgeons were 31% less likely to experience an operative injury (after adjustment for demographic variables and concomitant procedures). Similarly, being operated on by high-volume gynecologic surgeons decreased perioperative complications by 19%, medical complications by 24%, transfusions by 28%, and intensive care unit admission by 46%, although rates of readmission were 24% higher in patients treated by high-volume surgeons than in those treated by low-volume surgeons.

Treatment by high-volume surgeons also reduced the mean length of stay: 1.67 days compared with 1.94 days in patients treated by low-volume surgeons. In addition, operative times were highest for low-volume surgeons and decreased incrementally with surgeon volume (P<.001). Finally, the mean cost for vaginal hysterectomy performed by a low-volume surgeon was $5,246 compared with $4,550 for a high-volume surgeon. Overall gynecologic surgery volume had no apparent effect on cost, however; only high vaginal surgery volume was associated with decreased cost.

Rogo-Gupta LJ, Lewin SN, Kim JH, et al. The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy. Obstet Gynecol. 2010;116(6):1341-1347.