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

Mowat, Alex, Maher, Christopher and Ballard, Emma (2016) Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 215 1: 21-33. doi:10.1016/j.ajog.2016.02.048


Author Mowat, Alex
Maher, Christopher
Ballard, Emma
Title Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and metaanalysis
Journal name American Journal of Obstetrics and Gynecology   Check publisher's open access policy
ISSN 1097-6868
0002-9378
Publication date 2016-07-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.ajog.2016.02.048
Open Access Status Not Open Access
Volume 215
Issue 1
Start page 21
End page 33
Total pages 13
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2017
Language eng
Formatted abstract
Objective: The aim of this study was to determine the impact of gynecological surgeon volumes on patient outcomes.

Data Sources: Eligible studies were selected through an electronic literature search from database inception up until September 2015 and references in published studies. Search terms included surgical volume, surgeon volume, low-volume or high-volume, and gynecology or hysterectomy or sling or pelvic floor repair or continence procedure.

Study Eligibility: The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We defined a low-volume surgeon (LVS) as one performing the procedure once a month or less, and studies were excluded if their definition of LVS was > ±33% of our definition. Primary outcomes were total complications, intraoperative complications, and postoperative complications.

Study Appraisal and Synthesis Methods: All outcome data for individual studies were entered into systematic review software. When 2 or more studies evaluated a designated outcome, a meta-analysis of the entered data was undertaken as per the Cochrane database methodology. Data analysis was entered into a software product, which generated a summary of findings table that included structured and qualified grading (very low to high) of the quality for the evidence of the individual outcomes and provided a measure of effect.

Results: Fourteen peer-reviewed studies with 741,760 patients were included in the systematic review. For gynecology the LVS group had an increased rate of total complications (odds ratio [OR], 1.3, 95% confidence interval [CI], 1.2-1.5), intraoperative complications (OR, 1.6, 95% CI, 1.2-2.1), and postoperative complications (OR, 1.4 95% CI, 1.3-1.4). In gynecological oncology, the LVS group had higher mortality (OR, 1.9, 95% CI, 1.3-2.6). In the urogynecology group, a single study reported that the LVS group had a higher rate of any complication (risk ratio [RR], 1.4, 95% CI, -1.2-1.6). Another single study found that LVS had higher rates of reoperation for mesh complications after midurethral sling procedures (RR, 1.4, 95% CI, 1.2-1.5). The evidence is of moderate to very low quality.

Conclusion: Gynecologists performing procedures approximately once a month or less were found to have higher rates of adverse outcomes in gynecology, gynecological oncology, and urogynecology, with higher mortality in gynecological oncology.
Keyword Gynecology
Outcomes
Surgeon volume
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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