Annals of Surgical Oncology

, Volume 19, Issue 3, pp 948–958 | Cite as

Influence of Surgical Volume on Outcome for Laparoscopic Hysterectomy for Endometrial Cancer

  • Jason D. Wright
  • Dawn L. Hershman
  • William M. Burke
  • Yu-Shiang Lu
  • Alfred I. Neugut
  • Sharyn N. Lewin
  • Thomas J. Herzog
Gynecologic Oncology

Abstract

Purpose

The volume of surgical procedures performed by hospitals and surgeons has a strong influence on outcomes for a number of surgeries. We examined the influence of surgeon and hospital case volume on morbidity, mortality, and resource utilization for women with endometrial cancer undergoing laparoscopic hysterectomy.

Methods

Perspective, a nationwide inpatient database developed to measure utilization and quality, was used to examine women with endometrial cancer who underwent laparoscopic hysterectomy with or without lymphadenectomy from 2000 to 2010. Perioperative morbidity, mortality, and cost were compared using Chi-square tests and multivariable generalized estimating equations.

Results

A total of 4,137 patients were identified. The overall complication rate was 9.8% for low-volume vs. 10.4% for high-volume surgeons [multivariable odds ratio (OR) = 0.71; 95% confidence interval (CI), 0.41–1.22]. The rates of intraoperative complications, surgical-site complications, medical complications, transfusion, and reoperation were similar for patients treated by low- and high-volume surgeons (p > 0.05 for all). The adjusted estimate for hospital cost for patients treated by high- compared with low-volume surgeons was 219 USD (95% CI, −790 to 1,228 USD). The odds ratio for any complication in high- compared with low-volume hospitals was 1.24 (95% CI, 0.78–1.96). The average cost for patients treated in high- compared with low-volume facilities was −815 USD (95% CI, −1,641 to 11 USD). Neither physician nor hospital volume had a statistically significant effect on perioperative mortality.

Conclusion

Laparoscopic hysterectomy for endometrial cancer is well tolerated and associated with an acceptable morbidity profile. Surgeon and hospital volume appear to have little effect on perioperative morbidity, mortality, and resource utilization.

References

  1. 1.
    Chi DS, Abu-Rustum NR, Sonoda Y, et al. Ten-year experience with laparoscopy on a gynecologic oncology service: analysis of risk factors for complications and conversion to laparotomy. Am J Obstet Gynecol. 2004;191:1138–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010;11:763–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009;27:5331–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27:5337–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ. Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol. 2009;16:1799–808.PubMedCrossRefGoogle Scholar
  6. 6.
    Chan JK, Sherman AE, Kapp DS, et al. Influence of gynecologic oncologists on the survival of patients with endometrial cancer. J Clin Oncol. 2011;29:832–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Earle CC, Schrag D, Neville BA, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006;98:172–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Vernooij F, Heintz AP, Witteveen PO, van der Heiden-van der Loo M, Coebergh JW, van der Graaf Y. Specialized care and survival of ovarian cancer patients in The Netherlands: nationwide cohort study. J Natl Cancer Inst. 2008;100:399–406.PubMedCrossRefGoogle Scholar
  9. 9.
    Verhoef C, van de Weyer R, Schaapveld M, Bastiaannet E, Plukker JT. Better survival in patients with esophageal cancer after surgical treatment in university hospitals: a plea for performance by surgical oncologists. Ann Surg Oncol. 2007;14:1678–87.PubMedCrossRefGoogle Scholar
  10. 10.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRefGoogle Scholar
  11. 11.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.PubMedCrossRefGoogle Scholar
  12. 12.
    Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Gruen RL, Pitt V, Green S, Parkhill A, Campbell D, Jolley D. The effect of provider case volume on cancer mortality: systematic review and meta-analysis. CA Cancer J Clin. 2009;59:192–211.PubMedCrossRefGoogle Scholar
  14. 14.
    Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA. 2000;284:3028–35.PubMedCrossRefGoogle Scholar
  15. 15.
    Holub Z, Jabor A, Bartos P, Hendl J, Urbanek S. Laparoscopic surgery in women with endometrial cancer: the learning curve. Eur J Obstet Gynecol Reprod Biol. 2003;107:195–200.PubMedCrossRefGoogle Scholar
  16. 16.
    Lim PC, Kang E, Park do H. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol. 2011;120:413–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Lindenauer PK, Pekow PS, Lahti MC, Lee Y, Benjamin EM, Rothberg MB. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA. 2010;303:2359–67.PubMedCrossRefGoogle Scholar
  18. 18.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Hollenbeck BK, Wei Y, Birkmeyer JD. Volume, process of care, and operative mortality for cystectomy for bladder cancer. Urology. 2007;69:871–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245:777–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Rothberg MB, Pekow PS, Lahti M, Brody O, Skiest DJ, Lindenauer PK. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA. 2010;303:2035–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Khuri SF, Daley J, Henderson W, et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg. 1999;230:414–29; discussion 29–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Khuri SF, Henderson WG. The case against volume as a measure of quality of surgical care. World J Surg. 2005;29:1222–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Tunitsky E, Citil A, Ayaz R, Esin S, Knee A, Harmanli O. Does surgical volume influence short-term outcomes of laparoscopic hysterectomy? Am J Obstet Gynecol. 2010;203:24 e1–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Rogo-Gupta LJ, Lewin SN, Kim JH, et al. The effect of surgeon volume on outcomes and resource use for vaginal hysterectomy. Obstet Gynecol. 2010;116:1341–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Anger JT, Rodriguez LV, Wang Q, Pashos CL, Litwin MS. The role of provider volume on outcomes after sling surgery for stress urinary incontinence. J Urol. 2007;177:1457–62; discussion 62.PubMedCrossRefGoogle Scholar
  28. 28.
    Bristow RE, Zahurak ML, Diaz-Montes TP, Giuntoli RL, Armstrong DK. Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes. Gynecol Oncol. 2009;115:334–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Diaz-Montes TP, Zahurak ML, Giuntoli RL, 2nd, Gardner GJ, Bristow RE. Uterine cancer in Maryland: impact of surgeon case volume and other prognostic factors on short-term mortality. Gynecol Oncol. 2006;103:1043–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Juillard C, Lashoher A, Sewell CA, Uddin S, Griffith JG, Chang DC. A national analysis of the relationship between hospital volume, academic center status, and surgical outcomes for abdominal hysterectomy done for leiomyoma. J Am Coll Surg. 2009;208:599–606.PubMedCrossRefGoogle Scholar
  31. 31.
    Schrag D, Earle C, Xu F, et al. Associations between hospital and surgeon procedure volumes and patient outcomes after ovarian cancer resection. J Natl Cancer Inst. 2006;98:163–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Boyd LR, Novetsky AP, Curtin JP. Effect of surgical volume on route of hysterectomy and short-term morbidity. Obstet Gynecol. 2010;116:909–15.PubMedCrossRefGoogle Scholar
  33. 33.
    Wright JD, Lewin SN, Deutsch I, Burke WM, Sun X, Herzog TJ. Effect of surgical volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer. Obstet Gynecol. 2011;117:1051–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Chan JK, Kapp DS, Shin JY, et al. Influence of the gynecologic oncologist on the survival of ovarian cancer patients. Obstet Gynecol. 2007;109:1342–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Macdonald OK, Sause WT, Lee RJ, Dodson MK, Zempolich K, Gaffney DK. Does oncologic specialization influence outcomes following surgery in early stage adenocarcinoma of the endometrium? Gynecol Oncol. 2005;99:730–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Roland PY, Kelly FJ, Kulwicki CY, Blitzer P, Curcio M, Orr JW, Jr. The benefits of a gynecologic oncologist: a pattern of care study for endometrial cancer treatment. Gynecol Oncol. 2004;93:125–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Barkun JS, Aronson JK, Feldman LS, et al. Evaluation and stages of surgical innovations. Lancet. 2009;374:1089–96.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Jason D. Wright
    • 1
    • 4
  • Dawn L. Hershman
    • 2
    • 3
    • 4
  • William M. Burke
    • 1
  • Yu-Shiang Lu
    • 1
  • Alfred I. Neugut
    • 2
    • 3
    • 4
  • Sharyn N. Lewin
    • 1
    • 4
  • Thomas J. Herzog
    • 1
    • 4
  1. 1.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  3. 3.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  4. 4.Herbert Irving Comprehensive Cancer CenterNew YorkUSA

Personalised recommendations