The effect of physician experience on costs and clinical outcomes of laparoscopic-assisted vaginal hysterectomy: a multivariate analysis.
OBJECTIVE
To evaluate whether or not a physician's experience has an effect on costs and clinical outcomes of an implemented clinical pathway for laparoscopic-assisted vaginal hysterectomy (LAVH).


METHODS
Retrospective study (Canadian Task Force classification II-2).


METHODS
University hospital.


METHODS
One hundred twenty women.


METHODS
LAVHs, 84 performed by senior physicians and 36 by junior physicians.


RESULTS
According to results of multiple linear regression analysis, after controlling for other independent variables, senior attending physicians, each with over 6 years of experience, managed to reduce all costs related to LAVH, operating time, and length of stay. Logistic regression analysis revealed no differences in the occurrence of intravenous fluid injection, antibiotic injection more than 2 days after surgery, and complications between physicians with and those without experience. Neither group had blood transfusions, patient mortality, or readmissions within 2 weeks of discharge.


CONCLUSIONS
Physician experience reduces medical costs and maintains the quality of care in LAVH. We suggest regular training courses for less-experienced physicians in order to contain costs and maintain quality of care under the quota case-payment system.
Chang
Wei-Chun
WC
Department of Obstetrics and Gynecology, China Medical College Hospital, Taichung, Taiwan.
Li
Tsai-Chung
TC
Lin
Cheng-Chieh
CC
D000328:Adult; D016022:Case-Control Studies; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics* / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D016014:Linear Models; D016015:Logistic Models; D008505:Medical Staff, Hospital; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000601:surgery