OBJECTIVE To assess the relationship between surgeon volume and surgical approach for patients undergoing hysterectomy for benign indications among uteri of varying sizes. METHODS This was a retrospective cohort study of patients who underwent hysterectomy for benign indications from 2012 to 2021 within the Michigan Surgical Quality Collaborative registry. For each hysterectomy, the relative annual volume of the performing surgeon was assessed by calculating the proportion of hysterectomy cases contributed by the surgeon each calendar year relative to the total number of hysterectomies in the registry for that year. Hysterectomies were stratified into tertiles: those performed by low-volume surgeons, intermediate-volume surgeons, and high-volume surgeons. Uterine size was represented by the uterine specimen weight and categorized to facilitate clinical interpretation. Multivariable logistic regression models were developed incorporating interaction terms for surgeon volume and uterine size to explore potential effect modification. RESULTS A total of 54,150 hysterectomies were included. Hysterectomies performed by intermediate- and high-volume surgeons were more likely to be performed through a minimally invasive approach compared with those performed by low-volume surgeons (intermediate-volume: adjusted odds ratio [aOR] 1.68, 95% CI, 1.47-1.92; high-volume: aOR 2.14, 95% CI, 1.87-2.46). Moreover, this likelihood increased with increasing uterine weight. For uteri weighing between 1,000 g and 1,999 g, the odds of minimally invasive approach was significantly higher among intermediate-volume surgeons (aOR 3.38, 95% CI, 2.04-5.12) and high-volume (aOR 9.26, 95% CI, 5.64-15.2) surgeons, compared with low-volume surgeons. After including an interaction term for uterine weight and surgeon volume, we identified effect modification of surgeon volume on the relationship between uterine size and choice of minimally invasive surgery. CONCLUSION For uteri up to 3,000 g in weight, hysterectomies performed by high-volume surgeons have a higher likelihood of being performed through a minimally invasive approach compared with those performed by low-volume surgeons.

中文翻译：

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良性适应症子宫切除术的外科医生体积、手术入路和子宫大小之间的关联。


目的 评估不同大小子宫中因良性适应症接受子宫切除术的患者手术体积与手术入路之间的关系。方法 这是一项回顾性队列研究，针对 2012 年至 2021 年在密歇根外科质量合作登记处因良性适应症接受子宫切除术的患者。对于每次子宫切除术，通过计算外科医生每个日历年贡献的子宫切除术病例相对于当年登记处子宫切除术总数的比例来评估执行外科医生的相对年工作量。子宫切除术分为三分体：由低容量外科医生、中等容量外科医生和高容量外科医生进行的手术。子宫大小由子宫标本重量表示，并进行分类以促进临床解释。开发了多变量 logistic 回归模型，纳入了外科医生体积和子宫大小的交互项，以探索潜在的效果改变。结果 共纳入 54,150 例子宫切除术。与低容量外科医生进行的子宫切除术相比，中高容量外科医生进行的子宫切除术更有可能通过微创方法进行（中等容量：校正比值比 [aOR] 1.68,95% CI，1.47-1.92;高容量：aOR 2.14,95% CI，1.87-2.46）。此外，这种可能性随着子宫重量的增加而增加。对于体重在 1,000 g 至 1,999 g 之间的子宫，中等容量外科医生 （aOR 3.38,95% CI，2.04-5.12） 和高容量 （aOR 9.26,95% CI，5.64-15.2） 外科医生采用微创入路的几率显著高于低容量外科医生。 在纳入子宫重量和外科医生体积的交互项后，我们确定了外科医生体积的改变对子宫大小与微创手术选择之间关系的影响。结论 对于体重高达 3,000 g 的子宫，与低容量外科医生进行的子宫切除术相比，由大容量外科医生进行的子宫切除术更有可能通过微创方法进行。