Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and meta-analysis

Mowat, Alex; Maher, Christopher; Ballard, Emma

doi:10.1016/j.ajog.2016.02.048

Cited by 161 publications

(100 citation statements)

References 22 publications

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“…The importance of surgeon experience also cannot be overlooked, with previous studies showing an association between high‐volume surgeons and lower surgical complications, as well as same‐day discharge . The two surgeons who performed all surgeries in this study are both experienced, high‐volume surgical specialists who are especially proficient in the reported minimally invasive techniques.…”

Section: Discussionmentioning

confidence: 80%

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.

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Section: Discussionmentioning

confidence: 80%

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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show abstract

“…As for the surgical results of gynecologists, a previous meta‐analysis reported that when the number of operations was less than 1 case per month, the incidence of complications and mortality rate were significantly higher . Sharp et al evaluated published studies tracking clinical outcomes and certification status .…”

Section: Discussionmentioning

confidence: 99%

Relation between the number of board‐certified gynecologic oncologists per hospital and survival of cervical cancer

Yagi

Ueda

Nakagawa

et al. 2019

J of Obstet and Gynaecol

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Aims In cancer therapy, choice of treatment method has a tremendous influence on patient prognosis. We aimed to evaluate the impact of the number of Gynecologic Oncology (GO) Specialists on treatment outcomes of cervical cancer patients. Methods We used data for 5‐year treatment outcomes obtained from the annual treatment reports of the Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology (JSOG). We compared this to data posted on the Japanese Society of Gynecologic Oncology (JSGO) website regarding the enrollment of GO Specialists at each hospital. Results The 5‐year survival ratio of cervical cancer patients treated in hospitals with 2‐or‐more GO Specialists was 79.0% (2010/2543). This was significantly higher than 75.4% (974/1292) for facilities with 0 or 1 specialist (P = 0.011); however, the number of GO Specialists was not an independent prognostic factor (P = 0.77, adjusted HR: 1.13 [0.38–2.03]). The 5‐year survival ratio significantly increased in medical facilities whose number of GO Specialists increased from 0 to 1 or more, or from 1 to 2 or more (P = 0.045). Conclusion This study demonstrates a causal relationship between the numbers of GO Specialists and treatment outcomes of cervical cancer patients for the first time. Our study suggests that although JSGO board‐certified gynecologic oncologists do clearly contribute to improving treatment outcome, the number of specialists was not an independent factor for improving the prognosis of the patients. Thus, it was not clear whether simply increasing the number of GO Specialists, beyond two, will lead to any significant improvement in cervical cancer patient prognosis.

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“…This is an important consideration especially given that the specialty of obstetrics and gynecology is associated with extremely high rates of medical liability claims in the United States and is second only to neurosurgery. 18 Although data specific to the performance of intestinal surgery are lacking, previous data have shown that low volume gynecologic surgeons experience higher rates of complications and likely higher rates of malpractice suits. 18 This study is subject to the inherent selection and recall bias that are associated with elective survey-based reporting.…”

Section: Discussionmentioning

confidence: 99%

“…18 Although data specific to the performance of intestinal surgery are lacking, previous data have shown that low volume gynecologic surgeons experience higher rates of complications and likely higher rates of malpractice suits. 18 This study is subject to the inherent selection and recall bias that are associated with elective survey-based reporting. Furthermore, we were unable to connect responses to case log data reported to the ACGME to validate operative numbers.…”

Section: Discussionmentioning

confidence: 99%