Table 4.
Rates of outcomes and adjusted risk ratio of surgeon volume in patients with abdominal, robotically-assisted, laparoscopic, or vaginal hysterectomy.
| Abdominal | Robotic | Laparoscopic | Vaginal | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||||
| Other (%) |
VLV (%) |
aRR, VLV vs. other |
Other (%) |
VLV (%) |
aRR, VLV vs. other |
Other (%) |
VLV (%) |
aRR, VLV vs. other |
Other (%) |
VLV (%) |
aRR, VLV vs. other |
|
| Outcomes | ||||||||||||
| Any morbidity | 12.8% | 35.2% | 1.89 (1.79–2.01)* | 6.8% | 19.9% | 2.49 (1.90–3.27)* | 4.7% | 10.2% | 1.70 (1.47–1.98)* | 6.1% | 8.4% | 1.24 (1.06–1.46)* |
| Intraoperative complication | 3.7% | 12.6% | 2.34 (2.13–2.58)* | 3.2% | 9.9% | 2.87 (1.97–4.19)* | 2.3% | 4.0% | 1.79 (1.42–2.26)* | 2.0% | 2.8% | 1.21 (0.92–1.59) |
| Surgical site complication | 5.9% | 17.1% | 1.91 (1.76–2.08)* | 1.7% | 6.8% | 2.90 (1.82–4.63)* | 1.3% | 3.5% | 1.76 (1.37–2.27)* | 1.6% | 2.1% | 1.16 (0.85–1.60) |
| Medical complication | 6.5% | 21.0% | 2.03 (1.88–2.19)* | 2.9% | 9.0% | 2.46 (1.64–3.69)* | 1.7% | 5.1% | 1.98 (1.60–2.44)* | 3.2% | 4.9% | 1.42 (1.15–1.76)* |
| Transfusion | 16.3% | 43.2% | 1.76 (1.66–1.86)* | 4.4% | 15.5% | 2.44 (1.78–3.36)* | 4.4% | 12.4% | 1.52 (1.31–1.75)* | 6.0% | 11.7% | 1.41 (1.21–1.63)* |
| LOS >75% | 17.5% | 58.3% | 2.02 (1.92–2.13)* | 23.3% | 46.9% | 1.61 (1.34–1.93)* | 8.6% | 31.5% | 1.84 (1.68–2.03)* | 23.3% | 36.8% | 1.28 (1.18–1.40)* |
| Total charges>75% | 24.4% | 61.2% | 1.93 (1.83–2.03)* | 24.6% | 48.1% | 1.69 (1.41–2.03)* | 24.7% | 39.2% | 1.35 (1.24–1.47)* | 24.4% | 41.6% | 1.31 (1.21–1.42)* |
VLV: very low volume. aRR: adjusted risk ratio.
P-values of univariate analysis <0.001, except intraoperative complication (p=0.01), and surgical site complication (p=0.04) in vaginal hysterectomy patients.
Surgeon and hospital volume were calculated separately for each route of hysterectomy. For each outcome, separate mixed-effects log-Poisson models included surgeon volume, elective surgery, age, year of admission, race, insurance status, comorbidity, NYC hospital, hospital-level tertiles of hospital volume, concomitant procedures (omentectomy, LND, anterior, posterior and incontinence repair, oophorectomy and colpopexy), indications (leiomyoma, endometriosis, abnormal menstruation and bleeding, benign neoplasms and cysts, pelvic organ prolapse, endometrial hyperplasia with or without atypia, uterine, cervical, and ovarian/fallopian tube/peritoneal cancer). Surgeon and hospital identifiers were included as nested random intercepts to account for surgeon and hospital level of clustering. In the group of robotically-assisted hysterectomy, the model for surgical site complication did not adjust for race and insurance status, and the models for medical complication and transfusion did not adjust for insurance status because of convergence issues.
P<0.05