title: Impact of surgeon volume on patient safety in laparoscopic gynecologic surgery.
abstract: OBJECTIVE
  To determine the impact of surgeon volume on patient outcomes in gynecologic laparoscopic surgery.
  
  
  METHODS
  We reviewed all patients who underwent a laparoscopic procedure between January 2000 and December 2008. Surgeons were divided into 3 groups based on surgical volume. The mean number of surgeries per year was calculated for each surgeon. Means were categorized into 3 groups. The low-, medium-, and high-volume surgeon groups were compared with respect to level of surgical complexity and intraoperative and postoperative complications.
  
  
  RESULTS
  The study included 829 surgeries. Low-volume surgeons (n=5) performed 5 (31.3%) low-complexity, 10 (62.5%) intermediate-complexity, and 1 (6.3%) high-complexity procedures. Medium-volume surgeons (n=6) performed 26 (11.1%) low-complexity, 203 (86.8%) intermediate-complexity, and 5 (2.1%) high-complexity procedures. High-volume surgeons (n=5) performed 47 (8.1%) low-complexity, 439 (75.8%) intermediate-complexity, and 93 (16.1%) high-complexity procedures. The distribution of surgical complexity was significantly different between the 3 groups of surgeons defined by volume (P<0.001). Conversion rates were higher for low-volume surgeons when compared to high-volume surgeons (18.8% vs. 5.2%; P=0.04). Similarly, overall complication rates (<30 days) were higher for low-volume surgeons compared to high-volume surgeons (31.3% vs. 17%, P=0.003). Mean length of hospital stay was longer for low-volume (2.4 days) than for medium-volume (1.3 days) and high-volume surgeons (1.6 days) (P=0.003).
  
  
  CONCLUSIONS
  High- and medium-volume gynecologic laparoscopists performed a greater proportion of intermediate- and high-complexity procedures than did low-volume surgeons. High-volume surgeons have a lower rate of conversions, overall postoperative complications, and shorter mean length of hospital stay when compared to low volume surgeons.
authors.affiliation: Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Worley
authors.forename: Carlos
authors.initials: C
authors.lastname: Anwandter
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Ricardo
authors.initials: R
authors.lastname: dos Reis
authors.forename: Alpa M
authors.initials: AM
authors.lastname: Nick
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Charles F
authors.initials: CF
authors.lastname: Levenback
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult