Effect of surgeon case volume on major surgical complications for
abdominal and laparoscopic radical hysterectomy for cervical cancer in
China, 2004-2016: A retrospective cohort study
Abstract
Abstract Objectives: To examine changes in surgeon volume over time and
evaluate the influence of surgeon volume on complications of abdominal
radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH)
for cervical cancer. Design: A retrospective cohort study. Setting: 42
hospitals in China. Population: 14536 patients undergoing ARH and 8148
patients underwent LRH. Methods: The influence of the surgeon volume of
ARH and LRH on surgical complications was examined using multivariable
logistic regression models. Main outcome measures: Intraoperative
complications and postoperative complications. Results: In the ARH
cohort, the mean surgeon case volume increased from 3.5 cases in 2004 to
8.7 cases in 2013 and then decreased to 4.9 cases in 2016. The number of
surgeons performing LRH increased from 1 surgeon with 1 patient (mean
cases=1) in 2004 to 183 surgeons who operated on 2,206 patients in 2016
(mean cases=12.1) (P< 0.01). In the ARH, patients treated by
intermediate-volume surgeons had more postoperative complications
(OR=1.55, 95% CI=1.11-2.15). In the laparoscopic surgery cohort,
surgeon volume had no independent effect on intraoperative or
postoperative complications (P=0.46; P=0.13). Conclusions: The
performance of ARH by intermediate-volume surgeons is associated with an
increased risk of postoperative complications. However, surgeon volume
may have little effect on intraoperative or postoperative complications
after LRH.