Disparities in access to high volume surgeons within high volume hospitals for hysterectomy

Abstract

<h3>Objectives:</h3> The association between higher surgical volume and improved outcomes has been demonstrated for numerous surgical procedures, including hysterectomy. Little is known about disparities in care for women treated at high volume hospitals. We examined disparities in access to surgical care by high volume surgeons and outcomes among patients treated within high volume hospitals for women undergoing hysterectomy. <h3>Methods:</h3> All women who underwent hysterectomy in New York State between 2000 and 2014 at a high volume (top quartile by volume) hospital were included. Surgeons were classified into quartiles based on average annual procedural volume (Q1 lower to Q4 highest volume). Multivariable logistic regression models were used to determine clinical and demographic characteristics associated with treatment by a low volume (Q1) compared to a high volume (Q4) surgeon. The associations between surgeon volume and morbidity and mortality were also examined using log-linear regression models. <h3>Results:</h3> A total of 300,586 patients cared for by 5,505 surgeons at 59 hospitals were identified. Women treated by low volume compared to high volume surgeons were more often BlackBlack (19.4% vs 14.3%; aOR=1.25; 95% CI, 1.08-1.45) and Medicare recipients (20.6% vs 14.5%; aOR 1.22; 95% CI, 1.05-1.43). Low volume surgeons were more likely to perform abdominal hysterectomy (77.8% vs 54.7%; aOR 1.92; 95% CI, 1.64-2.26). Compared to patients cared for by high volume surgeons, those operated on by low volume surgeons had increased risk of any complication (31.0% vs 10.3%; aRR=1.85; 95% CI, 1.72-2.00), intraoperative complications (10.2% vs 3.3%; aRR=2.17; 95% CI, 1.91-2.45), surgical site complications (14.9% vs 4.3%; aRR=1.86; 95% CI, 1.68-2.05), medical complications (19.6% vs 5.1%; aRR=2.10; 95% CI, 1.89-2.33), and mortality (2.2% vs 0.16%; aRR=3.04; 95% CI, 2.20-4.21) (all P<0.0001). <h3>Conclusions:</h3> Among women who undergo hysterectomy at high volume hospitals, disparities remain in access to high volume surgeons. Within high volume hospitals, women who undergo hysterectomy by a low volume surgeon are at increased risk of perioperative morbidity and mortality.