title: Predictors of successful surgical outcome in laparoscopic hysterectomy.
abstract: OBJECTIVE
  To estimate, after correction for patient factors, to what extent blood loss, operative time, and adverse events are decisive factors for the successful outcome of laparoscopic hysterectomy. A secondary objective was to estimate to what extent a successful outcome can be predicted from surgical experience or other measures of surgical skill.
  
  
  METHODS
  A nationwide multivariate 1-year cohort analysis was conducted with gynecologists who perform laparoscopic hysterectomy. The primary outcomes were blood loss, operative time, and adverse events. The procedures were corrected for multiple covariates in a mixed-effects logistic regression model. Furthermore, all primary outcomes were related to experience and the influence of individual surgical skills factors.
  
  
  RESULTS
  One thousand five hundred thirty-four laparoscopic hysterectomies were analyzed for 79 surgeons. The success of the surgical outcome was significantly influenced by uterus weight, body mass index, American Society of Anesthesiologists Physical Status Classification, previous abdominal surgeries, and the type of laparoscopic hysterectomy. Surgical experience also predicted the successful outcome of laparoscopic hysterectomy with respect to blood loss and adverse events (P=.048 and .036, respectively). A significant improvement in surgical outcomes tends to continue up to approximately 125 procedures. Independently from surgical experience, an individual surgical skills factor was identified as odds ratio 1.67 and 3.60 for blood loss and operative time, respectively.
  
  
  CONCLUSIONS
  After adjusting for risk factors, it was shown that an increase in experience positively predicted a successful outcome in laparoscopic hysterectomy with respect to blood loss and adverse events. However, the independent surgical skills factor shows a large variation in proficiency between individuals. The fact that a surgeon has performed many laparoscopic hysterectomies does not necessarily guarantee good surgical outcome.
  
  
  METHODS
  II.
authors.affiliation: Department of Gynecology and Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands. A.R.H.Twijnstra@lumc.nl
authors.forename: Andries R
authors.initials: AR
authors.lastname: Twijnstra
authors.forename: Mathijs D
authors.initials: MD
authors.lastname: Blikkendaal
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: van Kesteren
authors.forename: Cor D
authors.initials: CD
authors.lastname: de Kroon
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016015:Logistic Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome