title: Effect of surgical volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer.
abstract: OBJECTIVE
  To estimate the effects of surgeon and hospital volume on perioperative morbidity and mortality in women who underwent hysterectomy for endometrial cancer.
  
  
  METHODS
  Patients who underwent abdominal hysterectomy for endometrial cancer between 2003 and 2007 and who recorded in an inpatient, acute-care database were examined. Procedure-associated intraoperative, perioperative, and postoperative medical complications, as well as hospital readmission, length of stay, intensive care unit (ICU) use, and mortality were examined. Surgeons and hospitals were stratified into volume-based tertiles and outcomes analyzed using multivariable, generalized estimating equations.
  
  
  RESULTS
  A total of 6,015 women were identified. After adjustment for case-mix variables and hospital volume, perioperative surgical complications (15.2% compared with 11.7%) (odds ratio [OR] 0.57; 95 confidence interval [CI] 0.38-0.85), medical complications (31.4% compared with 22.0%) (OR 0.57; 95% CI 0.37-0.88), and ICU utilization (8.9% compared with 3.5%) (OR 0.47; 95% CI 0.28-0.80) were lower in patients treated by high-volume surgeons. Surgeon volume had no independent effect on the rates of operative injury (OR 0.82; 95% CI 0.32-2.08), transfusion (OR 2.33; 95% CI 0.93-5.36), length of stay (OR 0.60; 95% CI 0.25-1.41), or readmission (OR 1.05; 95% CI 0.51-2.14). Whereas patients treated at high-volume hospitals were less likely to require ICU care (9.3% compared with 4.3%) (OR 0.44; 95% CI 025-0.77), hospital volume had no independent effect on any of the other primary outcomes of interest (P>.05 for all).
  
  
  CONCLUSIONS
  Perioperative surgical complications, medical complications, and ICU requirements are lower in patients treated by high-volume surgeons. Hospital volume had little independent effect on outcomes.
authors.affiliation: From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, and the Herbert Irving Comprehensive Cancer Center, New York, New York.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Israel
authors.initials: I
authors.lastname: Deutsch
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
mesh_terms: D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007044:Hysterectomy / Q000401:mortality / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States