Outcomes of Hysterectomy Performed by Very Low-Volume Surgeons
Open accessAbstract
OBJECTIVE: To perform a population-based analysis to first examine the changes in surgeon and hospital procedural volume for hysterectomy over time and then to explore the association between very low surgeon procedural volume and outcomes. METHODS: All women who underwent hysterectomy in New York State from 2000 to 2014 were examined. Surgeons were classified based on the average annual procedural volume as very low-volume surgeons if they performed one procedure per year. We used multivariable models to examine the association between very low-volume surgeon status and morbidity, mortality, transfusion, length of stay, and cost. RESULTS: Among 434,125 women who underwent hysterectomy, very low-volume surgeons accounted for 3,197 (41.0%) of the surgeons performing the procedures and operated on 4,488 (1.0%) of the patients. The overall complication rates were 32.0% for patients treated by very low-volume surgeons compared with 9.9% for those treated by other surgeons ( P <.001) (adjusted relative risk 1.97, 95% CI 1.86–2.09). Specifically, the rates of intraoperative (11.3% vs 3.1%), surgical site (15.1% vs 4.1%) and medical complications (19.5% vs 4.8%), and transfusion (38.5% vs 11.8%) were higher for very low-volume compared with higher volume surgeons ( P <.001 for all). Patients treated by very low-volume surgeons were also more likely to have a prolonged length of stay (62.0% vs 22.0%) and excessive hospital charges (59.8% vs 24.6%) compared with higher volume surgeons ( P <.001 for both). Mortality rate was 2.5% for very low-volume surgeons compared with 0.2% for higher volume surgeons ( P <.001) (adjusted relative risk 2.89, 95% CI 2.32–3.61). CONCLUSION: A substantial number of surgeons performing hysterectomy are very low-volume surgeons. Performance of hysterectomy by very low-volume surgeons is associated with increased morbidity, mortality, and resource utilization.
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Ruiz and Chen have shown that there were higher complication, transfusion and mortality rates for hysterectomies performed by inexperienced surgeons compared with experienced surgeons.
“Ruiz and Chen 36 have shown that there were higher complication, transfusion and mortality rates for hysterectomies performed by inexperienced surgeons compared with experienced surgeons.”
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- Authors
- Ruiz, M. P., Chen, L., Hou, J. Y., Tergas, A. I., St. Clair, C. M., Ananth, C. V., Neugut, A. I., Hershman, D. L., & Wright, J. D.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2018-06
- Volume
- 131
- Issue
- 6
- Pages
- 981-990
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC5970072
- OpenAlex
- W2800338049
- Cited by
- 69
- References
- 33
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 7 · 2023: 11 · 2022: 12 · 2021: 13 · 2020: 8 · 2019: 8 · 2018: 2
- FWCI
- 8.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01CA166084, R01CA169121)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- hysterectomy, surgeon volume, hospital volume, postoperative complications, surgical site infection, intraoperative complications, postoperative mortality, blood transfusion, length of hospital stay, hospital costs, resource utilization (health care)
- MeSH terms
- Adult, Aged, Female, Health Resources, Hospitals, Humans, Hysterectomy, Intraoperative Complications, Length of Stay, Middle Aged, New York, Postoperative Complications, Multivariate Analysis, Logistic Models
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