Wright JD, et al. - Researchers assessed changes over time in surgeon and hospital procedural volume for hysterectomy for endometrial cancer, as well as how changes in volume are associated with perioperative outcomes. Outcomes revealed a complex association between surgeon and hospital volume for endometrial cancer. Medium-volume hospitals and surgeons demonstrated an increased risk of adverse outcomes, while the lowest complication rates were noted for the highest volume surgeons and centers.

Methods

• Analysis of women who underwent abdominal or minimally invasive hysterectomy from 2000 to 2014 was performed using the Statewide Planning and Research Cooperative System database.
• Estimation of annualized surgeon and hospital volume was performed.
• Using modeling procedural volume as a continuous and categorical variable, researchers estimated the association between surgeon and hospital volume and perioperative morbidity, mortality, and resource utilization (transfusion, length of stay, hospital charges).

Results

• Researchers identified 44,558 women treated at 218 hospitals.
• A decrease in the number of surgeons performing cases each year was noted, from 845 surgeons with 2,595 patients (mean cases=3) in 2000 to 317 surgeons who operated on 3,119 patients (mean cases=10) (P < .001) in 2014; over the same time period (P=.29), the mean hospital volume increased from 14 to 32 cases.
• Stratification by surgeon volume quartiles suggested a morbidity rate of 14.6% among the lowest volume surgeons, 20.8% for medium–low, 15.7% for medium–high, and 14.1% for high-volume surgeons (P < .001).
• Multivariable models modeling volume as a continuous variable revealed no link between surgeon volume and the rate of complications, however excessive total charges were lowest and perioperative mortality highest for the high-volume surgeons (P < .001 for both).