8258 Does Uterine Size Matter? the Relationship between Surgeon Volume, Surgical Approach, and Uterine Weight for Benign Hysterectomy.

Abstract

<h3>Study Objective</h3> To assess the relationship between surgeon volume and surgical approach for benign hysterectomies across increasing uterine weights. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Hospitals in the Michigan Surgical Quality Collaborative (MSQC) registry between July 2012 and April 2021. <h3>Patients or Participants</h3> Patients undergoing benign hysterectomy. <h3>Interventions</h3> Hysterectomy. <h3>Measurements and Main Results</h3> For each hysterectomy, surgeon volume was determined by the number of hysterectomies contributed to the MSQC registry by the surgeon in the calendar year. Cases were classified into tertiles by surgeon volume. Multivariable logistic regression with interaction analysis was used to determine the likelihood of undergoing a minimally-invasive hysterectomy (MIH) by surgeon volume and uterine weight. Of the 59,356 patients, 47,149 (79.4%) patients underwent MIH and 12,207 (20.6%) underwent abdominal hysterectomy. The proportion of minimally-invasive hysterectomy (MIH) decreased with increasing uterine weight. Hysterectomies performed by high- and intermediate-volume surgeons were more likely to be minimally-invasive versus those performed by low-volume surgeons (high-volume: aOR 2.13 [95% CI 1.86-2.44]; intermediate-volume: aOR 1.74 [95% CI 1.52-2.00]). For hysterectomies performed by high-volume surgeons, the propensity for a minimally-invasive approach was amplified for uterine weights between 250-2000g, with the maximum interaction effect between 1000-2000g (aOR 4.23 [95% CI 2.57-6.96]). There was no interaction effect among weights below 250g or above 2000g. <h3>Conclusion</h3> Hysterectomies performed by high-volume surgeons are more likely to be associated with a minimally-invasive approach compared to those performed by low-volume surgeons among all uterine weights, but especially among uteri weighing between 250-1999g.