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

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.