COMMENTARY

How Does Surgical Volume Affect Gynecologic Surgery Outcomes?

Andrew M. Kaunitz, MD

Disclosures

October 03, 2016

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Hello. I'm Andrew Kaunitz, professor and associate chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Today I'd like to discuss surgical volume and outcomes of gynecologic surgery.

We have been aware for some time that patients of higher-volume surgeons have lower perioperative morbidity. However, for gynecologic procedures, it has not been clear whether such an inverse relationship between surgical volume and outcomes is present.

Investigators performed a review and meta-analysis of 14 reports that included almost 750,000 gynecologic surgeries.[1] Eleven of these reports were based in the United States and the remainder were from Holland and Canada. Those who performed surgery once a month or less frequently were considered low-volume surgeons. Hysterectomy and myomectomy procedures were categorized as gynecologic surgeries, endometrial and ovarian cancer procedures as oncology surgeries, and midurethral sling and pelvic reconstructive procedures as urogynecologic surgeries.

Overall, high-volume surgeons tended to operate on patients with more comorbidities. For gynecologic surgeries, low-volume surgeons had higher rates of intraoperative complications such as ureteral, bladder, bowel, and vascular injuries, as well as postoperative morbidity such as wound complications, hemorrhage, ileus, bowel obstruction, and venous thromboembolism. For oncology surgeries, patients of low-volume surgeons had higher perioperative mortality. One report found that among women undergoing surgery for ovarian cancer, 5-year survival was significantly higher with high-volume surgeons. In the urogynecologic category, one study found a higher rate of overall complications among patients of low-volume surgeons. Another noted a higher rate of reoperation for mesh complications following sling procedures performed by low-volume surgeons.

Recently, leaders at three US academic health systems announced a "Take the Volume Pledge" campaign to prevent certain surgeries (none of which are gynecologic) from being performed by low-volume surgeons.[2] This important article suggests that hospitals and particularly payers will increasingly be scrutinizing gynecologic surgeons' volume. Accordingly, gynecologic surgeons would be prudent to assess their own experience level as they plan surgical management of their patients.

Thank you for taking the time to view this video. I'm Andrew Kaunitz.

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