title: The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy.
abstract: OBJECTIVE
  To estimate the effect of surgical volume on outcomes and resource use in women undergoing vaginal hysterectomy.
  
  
  METHODS
  Women who underwent total vaginal hysterectomy and were registered in the Perspective database were examined. Perspective is a nationwide database developed to measure quality and resource use. Procedure-associated intraoperative, perioperative, and postoperative medical complications as well as hospital readmission, length of stay, intensive care unit (ICU) use, operating time, and cost were analyzed. Based on the overall gynecologic surgical volume and vaginal surgical volume of their surgeons, patients were stratified into tertiles. Complications were compared using adjusted generalized estimating equations and reported as odds ratios (ORs).
  
  
  RESULTS
  A total of 77,109 patients operated on by 6,195 gynecologic surgeons were identified. After adjustment for the effects of other demographic variables and concomitant procedures, patients operated on by high-volume vaginal surgeons were 31% (OR 0.69; 95% confidence interval [CI] 0.59-0.80) less likely to experience an operative injury, whereas perioperative complications were reduced by 19% (OR 0.81; 95% CI 0.72-0.92), medical complications decreased by 24% (OR 0.76; 95% CI 0.67-0.86), ICU admission reduced by 46% (OR 0.56; 95% CI 0.43-0.73), and the transfusion rate decreased by 28% (OR 0.72; 95% CI 0.61-0.85) in patients treated by high-volume vaginal surgeons, whereas rates of readmission were higher (OR 1.24; 95% CI 1.04-1.47) in patients treated by high-volume surgeons. Operative times were lower in patients operated on by high-volume surgeons (P<.001). Although total gynecologic surgical volume had no effect on cost, patients treated by high-volume vaginal surgeons had lower costs (P<.001).
  
  
  CONCLUSIONS
  Perioperative morbidity and resource use are lower in women undergoing vaginal hysterectomy when the procedure is performed by high-volume vaginal surgeons.
authors.affiliation: From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; and the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Rogo-Gupta
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000706:statistics & numerical data*; D007431:Intraoperative Complications; D007902:Length of Stay; D008875:Middle Aged; D016896:Treatment Outcome