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 Background To date, there are few studies that have investigated the association between surgeon volume and outcomes of radical hysterectomy. To examine changes in surgeon volume over time and evaluate the influence of surgeon volume on complications of abdominal and laparoscopic radical hysterectomy for cervical cancer. Methods We conducted a population-based retrospective study using the Major Surgical Complications of Cervical Cancer in China (MSCCCC) database to collect the data of patients who underwent radical hysterectomy from 2004–2016 at 42 hospitals. Patients were stratified into tertiles according to annualized surgeon volume. The influence of the surgeon volume of abdominal and laparoscopic radical hysterectomy on surgical complications was examined using multivariable logistic regression models. Results A total of 22,684 patients who underwent radical hysterectomy were identified. In the abdominal surgery 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 laparoscopic radical hysterectomy 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 abdominal surgery cohort, 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.