8344 The Impact of Surgeon Volume on Laparoscopic Hysterectomy Outcomes

Abstract

<h3>Study Objective</h3> To evaluate the impact of surgeon volume on outcomes after laparoscopic hysterectomy for benign indications. <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> Single tertiary care academic institution. <h3>Patients or Participants</h3> A total of 494 patients who underwent laparoscopic hysterectomy performed by 22 benign gynecologic surgeons. <h3>Interventions</h3> Laparoscopic or robotic-assisted hysterectomy performed between March 2019 and April 2020. <h3>Measurements and Main Results</h3> Of the total 494 benign laparoscopic hysterectomies performed, 448 hysterectomies were performed by high volume surgeons (9 surgeons) and 46 hysterectomies were performed by low volume surgeons (13 surgeons). High volume was defined as 12 or more hysterectomies completed during the study year. Low volume surgeons ranged from 1 to 8 hysterectomies performed during the study period. Demographic and preoperative characteristics were similar between groups except age (45 years vs 41 years, p=.033). The two groups had similar intraoperative characteristics including route of hysterectomy, operative time, estimated blood loss and uterine weight. Intraoperative complications were similar between groups including transfusion rates, viscus injury, and intraoperative consults. However, there was a significantly higher rate of intraoperative conversion to laparotomy in the lowvolume group (1% vs 9%, p=.004). Pathology results were similar between groups. No pathologic findings were seen in 16% of cases in the high-volume group and 26% of cases in the low volume group (p=.11). Endometriosis was confirmed on pathology similarly between groups (11% vs 9%, p=.78). Pathology outcomes of leiomyomas, adenomyosis, and endometrial hyperplasia were similar between groups. There were no differences in postoperative complications, emergency department visits, or readmissions. <h3>Conclusion</h3> Low volume surgeons had significantly higher rates of intraoperative conversion to laparotomy at time of laparoscopic hysterectomy. In this study, surgeon volume did not significantly impact other outcomes including pathology. However, a limitation of the study was the small sample size in the low volume group which was <10% of the cohort.