title: The Impact of Individual Surgeon Volume on Hysterectomy Costs.
abstract: OBJECTIVE
  Hysterectomy is one of the most common surgical procedures women will undergo in their lifetime. Several factors affect surgical outcomes. It has been suggested that high-volume surgeons favorably affect outcomes and hospital cost. The objective is to determine the impact of individual surgeon volume on total hospital costs for hysterectomy.
  
  
  METHODS
  This is a retrospective cohort of women undergoing hysterectomy for benign indications from 2011 to 2013 at 10 hospitals within the University of Pittsburgh Medical Center System. Cases that included concomitant procedures were excluded. Costs by surgeon volume were analyzed by tertile group and with linear regression.
  
  
  RESULTS
  We studied 5,961 hysterectomies performed by 257 surgeons: 41.5% laparoscopic, 27.9% abdominal, 18.3% vaginal, and 12.3% robotic. Surgeons performed 1-542 cases (median = 4, IQR = 1-24). Surgeons were separated into equal tertiles by case volume: low (1-2 cases; median total cost, $4,349.02; 95% confidence interval [CI] [$3,903.54-$4,845.34]), medium (3-15 cases; median total cost, $2,807.90; 95% CI [$2,693.71-$2,926.93]) and high (>15 cases, median total cost $2,935.12, 95% CI [$2,916.31-$2,981.91]). ANOVA analysis showed a significantdecrease(P< .001) in cost from low-to-medium- and low-to-high-volume surgeons. Linear regression showed a significant linear relationship (P< .001), with a $1.15 cost reduction per case with each additional hysterectomy. Thus, if a surgeon performed 100 cases, costs were $115 less per case (100 × $1.15), for a total savings of $11,500.00 (100 × $115).
  
  
  CONCLUSIONS
  Overall, in our models, costs decreased as surgeon volume increased. Low-volume surgeons had significantly higher costs than both medium- and high-volume surgeons.
authors.affiliation: Department of Obstetrics and Gynecology, St Francis Hospital and Medical Center, Hartford, Connecticut, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Charelle M
authors.initials: CM
authors.lastname: Carter-Brooks
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Kantartzis
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Pittsburgh, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bonidie
mesh_terms: D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D016014:Linear Models; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Cost analysis; Gynecology; Hysterectomy; Minimally invasive surgery