Objective
The volume of surgical procedures performed by hospitals and surgeons has a strong influence on outcomes for a number of high-risk oncologic procedures. We examined the influence of surgeon and hospital case volume on morbidity and mortality for women with endometrial cancer undergoing laparoscopic hysterectomy.
Methods
The Perspective database was utilized to examine all women with endometrial cancer who underwent laparoscopic hysterectomy with or without lymphadenectomy from 2000-2010. Perioperative morbidity and mortality were compared using chi square tests and multivariable generalized estimating equations.
Results
A total of 4137 patients were identified. Compared to women treated by low-volume surgeons, those operated on by high volume surgeons were older, more often non-white, less likely to have commercial insurance, more commonly resided in urban areas and were more frequently treated at large, teaching hospitals (p<0.05 for all). The rates of intraoperative complications (3.7% low-volume vs. 3.0% high-volume), surgical site complications (3.4% vs. 3.5%), medical complications (4.2% vs. 5.4%), transfusion (2.3% vs. 2.5%), reoperation (0.5% vs. 0.4%), conversion to laparotomy (0.7% vs. 0.3%), and prolonged hospitalization (15.9% vs. 12.2%) were not statistically significantly different between low and high-volume surgeons (p=NS for all). Likewise, while hospital volume was associated with a higher rate of medical complications (3.3% low-volume vs. 4.7% high-volume), no other differences in morbidity were noted. These findings were confirmed in multivariable analyses.
Conclusion
Laparoscopic hysterectomy for endometrial cancer is well tolerated and associated minimal morbidity. Surgeon and hospital volume appear to have little effect on perioperative morbidity and mortality.
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