Impact of surgeon and hospital volumes on short-term postoperative complications after radical hysterectomy for cervical cancer.
OBJECTIVE
The association between provider caseload volumes and patient outcomes remains unclear in gynecologic cancer surgery, especially with regard to radical hysterectomies. The present study aims to clarify the effect of provider volumes on short-term postoperative complications after radical hysterectomy for cervical cancer.


METHODS
We conducted a multicenter study of cervical cancer patients undergoing radical hysterectomy in Japan from October 1, 2006 to February 28, 2007, by collecting medical record-based data on each patient's background, operating time and postoperative complications, as well as hospital/surgeon volumes. Multivariate analyses were performed to examine the effect of hospital/surgeon volumes on operating time and postoperative complications, with adjustments for possible confounders.


RESULTS
We collected 407 cases from 84 hospitals around Japan. Higher surgeon volume (> or =200 procedures) was associated with shorter operating times (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16-0.86; P = 0.02) and reduced incidence of postoperative urinary disorders (OR, 0.45; 95% CI, 0.21-0.96; P = 0.04). Hospital volume was not an independent predictor of any of the outcomes.


CONCLUSIONS
Our results indicate that the rate of postoperative urinary disorders may be a possible benchmark that reflects a surgeon's skill in radical hysterectomy. Thus, high surgeon volume may be a proxy for high quality of care; practice could indeed make perfect in this clinical setting.
Yasunaga
Hideo
H
Department of Health Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. yasunagah-jyo@h.u-tokyo.ac.jp
Nishii
Osamu
O
Hirai
Yasuo
Y
Ochiai
Kazunori
K
Matsuyama
Yutaka
Y
Ohe
Kazuhiko
K
D000328:Adult; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D016526:Workload