title: The impact of surgeon volume on perioperative outcomes in hysterectomy.
abstract: OBJECTIVE
  To estimate the effect of surgeon volume on key perioperative outcomes after all modes of hysterectomy.
  
  
  METHODS
  We performed a review of 1914 hysterectomies performed at a large, academic tertiary-care hospital. Women who underwent abdominal, laparoscopic, vaginal, or robotic hysterectomy for benign non-obstetric indications in 2006, 2009, and 2010 were included.
  
  
  RESULTS
  Gynecologic surgeons were categorized according their average annual hysterectomy case volume: low volume (<11 cases per year), intermediate volume (11-50 cases per year), and high-volume (>51 cases per year). Taking all modes of hysterectomy together, surgeries performed by high-volume surgeons required a shorter operative time (155.11 minutes vs 199.19 -203.35 minutes, P<.001) and resulted in less estimated blood loss compared with low- and intermediate-volume surgeons (161.09 mL vs 205.58 -237.96 mL, P<.001). The 3 surgical volume groups did not differ from each other significantly in the conversion to laparotomy, readmission rate, or incidence of intraoperative or postoperative complications. These findings were maintained when subgroup analyses were performed by type of hysterectomy, with few exceptions. In the subgroup of vaginal hysterectomies by intermediate-volume surgeons, there were slightly more postoperative complications. There were fewer intraoperative complications in laparoscopic/robotic hysterectomies performed by high-volume surgeons, though not statistically significant.
  
  
  CONCLUSIONS
  Hysterectomies performed by high-volume surgeons at our institution during the 3-year study period were associated with shorter operative times and less estimated blood loss.
authors: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands; Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Florentien E M
authors: FE
authors: Vree
authors: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USADivision of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
authors: Sarah L
authors: SL
authors: Cohen
authors: Department of Obstetrics and Gynecology, Flushing Hospital Medical Center, Queens, NY, USA.
authors: Niraj
authors: N
authors: Chavan
authors: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, ASB 1-3, Boston, MA 02115, USA. jeinarsson@partners.org.
authors: Jon I
authors: JI
authors: Einarsson
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016063:Blood Loss, Surgical; D001900:Boston; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000706:statistics & numerical data*; D061646:Operative Time; D011183:Postoperative Complications; D011247:Pregnancy; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers