Ethical Considerations Arising From Surgeon Caseload Volume in Benign Gynecologic Surgery

Moawad, Gaby; Tyan, Paul; Corpodean, Florina; Robinson, James K.

doi:10.1016/j.jmig.2018.03.009

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…The procedure must be performed many times to lower the risk of complications and incidence of injuries. 29 We found surgery time to decrease first, and then the complication rate was lowered. The difference between these types of learning curves should be acknowledged and taken into account when RASC or RSCR is started.…”

Section: Results Of the Study In The Context Of Other Observationsmentioning

confidence: 85%

Learning curve of robot-assisted laparoscopic sacrocolpo(recto)pexy: a cumulative sum analysis

Zanten

Koops

Jong

et al. 2019

American Journal of Obstetrics and Gynecology

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Section: Results Of the Study In The Context Of Other Observationsmentioning

confidence: 85%

Learning curve of robot-assisted laparoscopic sacrocolpo(recto)pexy: a cumulative sum analysis

Zanten

Koops

Jong

et al. 2019

American Journal of Obstetrics and Gynecology

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“…In addition to strategies targeting referral to centres of excellence, provision of surgical volume data to patients has been proposed as a strategy to optimise outcomes. 20 Further studies are warranted to externally validate the volume-outcome relationship in surgical treatment for PAS. The importance of comprehensive multidisciplinary care for PAS was endorsed in the 2018 obstetrics care consensus per the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine as well as in the 2019 Society of Obstetricians and Gynaecologists of Canada.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our observation, addressing the volume–outcome association in this complex pelvic surgery may be a key component in optimising the surgical outcomes of PAS. In addition to strategies targeting referral to centres of excellence, provision of surgical volume data to patients has been proposed as a strategy to optimise outcomes 20 . Further studies are warranted to externally validate the volume–outcome relationship in surgical treatment for PAS.…”

Section: Discussionmentioning

confidence: 99%

Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum

Matsuo

Youssefzadeh

Mandelbaum

et al. 2021

BJOG

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“…The operating surgeons are all fellowship-trained gynecologic subspecialists with surgical volumes likely to exceed those of obstetrics and gynecology specialists. Studies have consistently shown that high-volume surgeons have better complication management rates than low-volume surgeons [2]. Furthermore, the authors report that only 12% of the subjects undergoing TVH had a history of CS.…”

mentioning

confidence: 98%

Regarding “Perioperative Outcomes of Total Vaginal Hysterectomy in Women with Prior Cesarean Delivery”

Wagner

Wegleitner

2021

Journal of Minimally Invasive Gynecology

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We read with great interest the article by Delara et al. [1] evaluating the safety of total vaginal hysterectomy (TVH) for patients with prior cesarean section (CS). A history of CS is a commonly encountered risk factor in women considering hysterectomy. When interpreting the authors' conclusions, context is important. The operating surgeons are all fellowship-trained gynecologic subspecialists with surgical volumes likely to exceed those of obstetrics and gynecology specialists. Studies have consistently shown that high-volume surgeons have better complication management rates than low-volume surgeons [2]. Furthermore, the authors report that only 12% of the subjects undergoing TVH had a history of CS. Although varying by region, CS rates generally exceed 25% [3]. This lower CS rate in the study population suggests the presence of selection bias, which most likely leans in the direction of including for favorable CS subjects. Combined, these points demonstrate that the authors are presenting a "best case" scenario. Complication rates may well be higher for women with a history of CS who elect to undergo TVH in the population at large.The most striking initial finding in this paper is a 5.6% transfusion rate in the CS group compared with 0.6% in the control group (p <.05 as reported in the abstract and results narrative). The magnitude of this finding-a more than 9fold increase in risk-was not highlighted in this study. We would ask the authors if it would have been reasonable to conclude, on the basis of these data alone, that surgeons should use caution in choosing TVH for women with a history of CS if they wish to minimize the transfusion risk. Furthermore, why did they report p <.05 in both the abstract and results when the actual p-value calculated by the Fisher exact test (line 6 of Table 3) is in fact p = .002? Was this intended to minimize the significance of this finding?Further review identified a discrepancy between the authors' main conclusion and their supporting evidence. The main conclusion is that ". . .a prior history of CS. . . did not increase the risk for overall perioperative complications." The authors find a 2.9% major complication rate in the control group vs a 11.2% rate in the CS group. These numbers are presented in neither the abstract nor the results narrative. Considering that the presentation of these data is the authors' stated primary objective, it is puzzling that one can only find

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Ethical Considerations Arising From Surgeon Caseload Volume in Benign Gynecologic Surgery

Cited by 7 publications

References 11 publications

Learning curve of robot-assisted laparoscopic sacrocolpo(recto)pexy: a cumulative sum analysis

Learning curve of robot-assisted laparoscopic sacrocolpo(recto)pexy: a cumulative sum analysis

Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum

Regarding “Perioperative Outcomes of Total Vaginal Hysterectomy in Women with Prior Cesarean Delivery”

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