Impact of surgeon volume on patient safety in laparoscopic gynecologic surgery

Objective: To determine the impact of surgeon volume on patient outcomes in gynecologic laparoscopic surgery. Methods: 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. Results: 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). Conclusion: 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.