Open AccessAssessment of surgeon and hospital volume for robot‐assisted and laparoscopic benign hysterectomy in Sweden
Author(s) -
Brunes Malin,
Forsgren Catharina,
Warnqvist Anna,
Ek Marion,
Johannesson Ulrika
Publication year - 2021
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.14166
Subject(s) - medicine , hysterectomy , blood loss , odds ratio , surgery , laparoscopic hysterectomy , blood transfusion , laparoscopy
The study aims to analyze differences between robot‐assisted total laparoscopic hysterectomy (RATLH) and total laparoscopic hysterectomy (TLH) in benign indications, emphasizing surgeon and hospital volume. Material and methods All women in Sweden undergoing a total hysterectomy for benign indications with or without a bilateral salpingo‐oophorectomy from January 1, 2015 to December 31, 2017 ( n = 12 386) were identified from three national Swedish registers. Operative time, blood loss, conversion rate, complications, readmission, reoperation, length of hospital stays, and time to daily life activity were evaluated by univariable and multivariable regression models in RATLH and TLH. Surgeon and hospital volume were obtained from the Swedish National Quality Register of Gynecological Surgery and divided into subclasses. Results TLH was associated with a higher rate of intraoperative complications (adjusted odds ratios [aOR] 2.8, 95% CI 1.3–5.8) and postoperative bleeding complications (aOR 1.8, 95% CI 1.2–2.9) compared with RATLH. Intraoperative data showed a higher conversion rate (aOR 13.5, 95% CI 7.2–25.4), a higher blood loss (200–500 mL aOR 3.5, 95% CI 2.7–4.7; > 500 mL aOR 7.6, 95% CI 4.0–14.6) and a longer operative time (1–2 h aOR 16.7 95% CI 10.2–27.5; >2 h aOR 47.6, 95% CI 27.9–81.1) in TLH compared with RATLH. The TLH group had a lower caseload per year than the RATLH group. Higher surgical volume was associated with lower median blood loss, shorter operative time, a lower conversion rate, and a lower perioperative complication rate. Differences in conversion rate or operative time in RATLH were not affected by surgeon volume when compared with TLH. One year after surgery, patient satisfaction was higher in RATLH than in TLH (aOR 0.6, 95% CI 0.4–0.9). Conclusions RATLH led to better perioperative outcome and higher patient satisfaction 1 year after surgery. These outcome differences were slightly more pronounced in very low‐volume surgeons but persisted across all surgeon volume groups.