Table 1.
Demographics of the patients who had hysterectomy by surgeon volume.
| Higher Volume Surgeons | Very Low Volume Surgeons | p-value | |||
|---|---|---|---|---|---|
|
| |||||
| N | (%) | N | (%) | ||
| Number of surgeons | 4,600 | (59.0%) | 3,197 | (41.0%) | |
| Number of patients | 429,637 | (99.0) | 4,488 | (1.0) | |
| Hysterectomy | <0.001 | ||||
| Abdominal | 256,202 | (59.6) | 3,582 | (79.8) | |
| Robotic | 17,696 | (4.1) | 89 | (2.0) | |
| Laparoscopic | 93,988 | (21.9) | 484 | (10.8) | |
| Vaginal | 61,751 | (14.4) | 333 | (7.4) | |
| Elective surgery | <0.001 | ||||
| Elective | 339,590 | (79.0) | 2,908 | (64.8) | |
| Emergent/urgent | 36,664 | (8.5) | 1,399 | (31.2) | |
| Other/unknown | 53,383 | (12.4) | 181 | (4.0) | |
| Age (years) | <0.001 | ||||
| <40 | 62,242 | (14.5) | 484 | (10.8) | |
| 40–49 | 186,456 | (43.4) | 1,531 | (34.1) | |
| 50–59 | 93,834 | (21.8) | 1,026 | (22.9) | |
| 60–69 | 49,733 | (11.6) | 665 | (14.8) | |
| ≥70 | 37,372 | (8.7) | 782 | (17.4) | |
| Year of admission | <0.001 | ||||
| 2000 | 29,711 | (6.9) | 422 | (9.4) | |
| 2001 | 30,017 | (7.0) | 375 | (8.4) | |
| 2002 | 31,189 | (7.3) | 368 | (8.2) | |
| 2003 | 29,727 | (6.9) | 358 | (8.0) | |
| 2004 | 30,173 | (7.0) | 330 | (7.4) | |
| 2005 | 29,685 | (6.9) | 299 | (6.7) | |
| 2006 | 28,783 | (6.7) | 296 | (6.6) | |
| 2007 | 27,923 | (6.5) | 263 | (5.9) | |
| 2008 | 27,797 | (6.5) | 288 | (6.4) | |
| 2009 | 28,140 | (6.5) | 256 | (5.7) | |
| 2010 | 28,608 | (6.7) | 227 | (5.1) | |
| 2011 | 27,667 | (6.4) | 227 | (5.1) | |
| 2012 | 27,076 | (6.3) | 235 | (5.2) | |
| 2013 | 27,158 | (6.3) | 256 | (5.7) | |
| 2014 | 25,983 | (6.0) | 288 | (6.4) | |
| Race/ethnicity | <0.001 | ||||
| White | 266,010 | (61.9) | 2,497 | (55.6) | |
| Black | 69,315 | (16.1) | 913 | (20.3) | |
| Hispanic | 39,788 | (9.3) | 454 | (10.1) | |
| Other | 38,437 | (8.9) | 434 | (9.7) | |
| Unknown | 16,087 | (3.7) | 190 | (4.2) | |
| Insurance status | <0.001 | ||||
| None | 10,390 | (2.4) | 115 | (2.6) | |
| Private | 321,633 | (74.9) | 2,875 | (64.1) | |
| Medicare | 54,674 | (12.7) | 979 | (21.8) | |
| Medicaid | 33,654 | (7.8) | 453 | (10.1) | |
| Other | 848 | (0.2) | 16 | (0.4) | |
| Unknown | 8,438 | (2.0) | 50 | (1.1) | |
| Comorbidity | <0.001 | ||||
| 0 | 190,897 | (44.4) | 1,340 | (29.9) | |
| 1 | 124,184 | (28.9) | 1,189 | (26.5) | |
| ≥2 | 114,556 | (26.7) | 1,959 | (43.6) | |
| New York city hospital | 154,826 | (36.0) | 2,146 | (47.8) | <0.001 |
| Hospital volume | <0.001 | ||||
| Low | 13,043 | (3.0) | 263 | (5.9) | |
| Medium | 81,670 | (19.0) | 854 | (19.0) | |
| High | 334,924 | (78.0) | 3,371 | (75.1) | |
| Other procedures | |||||
| Exenteration | 109 | (0.03) | 19 | (0.4) | <0.001 |
| Omentectomy | 27,519 | (6.4) | 555 | (12.4) | <0.001 |
| Debulk | 1,272 | (0.3) | 11 | (0.2) | 0.53 |
| Lymphadenectomy | 43,574 | (10.1) | 559 | (12.5) | <0.001 |
| Small bowel resection | 1,859 | (0.4) | 176 | (3.9) | <0.001 |
| Colon resection | 2,835 | (0.7) | 348 | (7.8) | <0.001 |
| Rectosigmoid resection | 3,657 | (0.9) | 528 | (11.8) | <0.001 |
| Liver resection | 323 | (0.1) | 26 | (0.6) | <0.001 |
| Bladder resection | 554 | (0.1) | 173 | (3.9) | <0.001 |
| Diaphragm resection | 943 | (0.2) | 14 | (0.3) | 0.19 |
| Splenectomy | 550 | (0.1) | 21 | (0.5) | <0.001 |
| Anterior repair | 36,820 | (8.6) | 201 | (4.5) | <0.001 |
| Posterior repair | 30,752 | (7.2) | 162 | (3.6) | <0.001 |
| Incontinence repair | 29,149 | (6.8) | 191 | (4.3) | <0.001 |
| Oophorectomy | 256,682 | (59.7) | 3,214 | (71.6) | <0.001 |
| Colpopexy | 29,765 | (6.9) | 163 | (3.6) | <0.001 |
| Indications for surgery | |||||
| Leiomyoma | 249,778 | (58.1) | 2,220 | (49.5) | <0.001 |
| Endometriosis | 115,310 | (26.8) | 790 | (17.6) | <0.001 |
| Abnormal menstruation and bleeding | 158,590 | (36.9) | 994 | (22.1) | <0.001 |
| Benign neoplasms and cysts | 118,933 | (27.7) | 1,076 | (24.0) | <0.001 |
| Pelvic organ prolapse | 68,312 | (15.9) | 404 | (9.0) | <0.001 |
| Endometrial hyperplasia with atypia | 5,697 | (1.3) | 25 | (0.6) | <0.001 |
| Endometrial hyperplasia without atypia | 15,887 | (3.7) | 102 | (2.3) | <0.001 |
| Uterine cancer | 45,062 | (10.5) | 356 | (7.9) | <0.001 |
| Cervical cancer | 6,517 | (1.5) | 53 | (1.2) | 0.07 |
| Ovarian, fallopian tube, peritoneal cancer | 17,402 | (4.1) | 353 | (7.9) | <0.001 |
VLV: very low volume.
Surgeon volume and hospital volume were calculated for any hysterectomy. Hospital volume tertiles were calculated at hospital-level.