Impact of surgeon volume on patient safety in laparoscopic gynecologic surgery

To determine the impact of surgeon volume on patient outcomes in gynecologic laparoscopic surgery.

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.

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).

High- and medium-volume gynecologic laparoscopists performed a greater proportion of intermediate- and high-complexity procedures than did low-volume surgeons. High-volume surgeons have a lower rate of conversions, overall postoperative complications, and shorter mean length of hospital stay when compared to low volume surgeons.