You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy III1 Apr 2018MP75-04 THE EFFECT OF SURGEON VOLUME ON PERIOPERATIVE OUTCOMES FOR MID-URETHRAL SLING SURGERY Jacqueline Speed, Ye Wang, Steven Chang, and Elodi Dielubanza Jacqueline SpeedJacqueline Speed More articles by this author , Ye WangYe Wang More articles by this author , Steven ChangSteven Chang More articles by this author , and Elodi DielubanzaElodi Dielubanza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2096AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Higher surgical volume is associated with decreased costs, complication rates, and length of stay in many urologic procedures. We sought to examine if surgeon volume is a predictor of perioperative outcomes in mid-urethral sling (MUS) placement. METHODS We utilized the Premier Healthcare Database, a national hospital discharge database representing 700 non-federal US hospitals, to identify patients who underwent MUS placement from 2003-2015. Those undergoing concomitant procedures or who received mini-slings were excluded. Patients were stratified by their surgeon's volume. Low, intermediate, and high volume were defined as <4, 4-9, and >9 MUS procedures per year, respectively. We examined patient demographics, Charlson comorbidity index (CCI), length of stay (LOS), readmission rates, and direct hospital costs, as well as hospital and surgeon characteristics. Univariate logistic regression analysis and a median regression of costs were performed. Multivariable regression was performed to identify for potential confounders. RESULTS We identified 30,433 patients, of which 49.2%, 28.0%, and 22.8% had surgery performed by a high, intermediate, and low-volume surgeon, respectively. Compared to low volume surgeons, high volume surgeons were more likely to see older patients in community-based hospital settings (42.6% vs 31.1%) and use a transobturator vs. retropubic approach (60.9% vs 58.5%). On univariate analysis, high and intermediate-volume surgeons had lower median hospital costs ($4505 and $4598 vs $4964, p<0.001) and lower incidence of prolonged LOS (14.7% and 14.6% vs 19.7%, p<0.001) compared to the low-volume group. There was no difference in readmission. On multivariate analysis, controlling for age, race, and CCI, there remained a lower median cost for intermediate and high-volume surgeons (-$352 (IQR -$422 to -$282) and -$455 (IQR -$517 to -$392), respectively, p<0.001) as well as a lower risk of prolonged LOS (OR 0.70 (95% CI 0.64-0.76) and OR 0.69 (95% CI 0.64-0.75), respectively, p<0.001) compared to low-volume surgeons. Notably, while the readmission rate was low overall, patients of high volume surgeons were more likely to be readmitted than those of low volume surgeons (OR 1.20 (95% CI 1.02-1.41), p=0.026). CONCLUSIONS Higher surgical volume is associated with lower costs and lower incidence of prolonged length of stay but a slightly higher rate of readmission. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1009 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jacqueline Speed More articles by this author Ye Wang More articles by this author Steven Chang More articles by this author Elodi Dielubanza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...