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). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. CONCLUSION-High- Conflict of Interest StatementThe authors report no conflict of interest. NIH Public Access

Compared Outcomes of Concurrent versus Staged Transoral Robotic Surgery with Neck Dissection

“…This likely reflects that our risk adjustment did not completely correct for the complexity of the patient/procedure that HVS undertake. 18 Gastrostomy and tracheostomy rates in this study were 23.1% and 13.2%, respectively. This is reasonable given that the published perioperative rates of these procedures are estimated at 4% to 14% for gastrostomy and 1% to 7% for tracheostomy, and these published numbers do not take into account the effects of adjuvant therapy.…”

“…After risk adjustment, HVS were independently associated with a complicated postoperative course. This likely reflects that our risk adjustment did not completely correct for the complexity of the patient/procedure that HVS undertake 18 …”

Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches

“…Concentrating these kinds of care at fewer sites could reduce costs of care and improve quality (Sternberg and Dougherty, 2015). Recent studies have indicated that a low volume of care in a particular area, for even routine surgeries, is associated with poor outcomes (Ley, 2014;Sternberg and Dougherty, 2015;Worley et al, 2012). Centralization efforts around care quality could both reduce system-level inefficiencies and increase alignment of the triple mission (patient care, education, and research).…”