The aim of the study was to compare access to high-volume surgeons against low-volume surgeons who conduct hysterectomies at high-volume hospitals, as well as perioperative morbidity and mortality between these centres’ high-volume and low-volume doctors. Women who had hysterectomies at a high-volume hospital in New York State between 2000 and 2014 were included in the study. Based on their average yearly hysterectomy volume, surgeons were divided into quartiles. Multivariable models were used to compare features associated with treatment by a low-volume surgeon to those associated with treatment by a high-volume surgeon, as well as to estimate the relationship between physician volume and morbidity and death. A total of 300,586 patients were identified who were cared for by 5,505 surgeons at 59 institutions. Women treated by low-volume surgeons were more likely to be Black and to have Medicare insurance than women treated by high-volume surgeons. When compared to minimally invasive hysterectomy, low-volume surgeons were more likely to conduct both emergent–urgent operations and abdominal hysterectomy. Those operated on by low-volume surgeons had a higher risk of complication and death when compared to patients operated on by high-volume surgeons. In sensitivity studies, there were no differences in morbidity and mortality across emergent–urgent procedures, elective procedures, cancer surgery, and noncancer procedures.
Socioeconomic inequalities in access to high-volume surgeons within high-volume institutions for hysterectomy continue to exist. Patients who have a hysterectomy performed at a high-volume institution by a low-volume surgeon are at a much higher risk of perioperative morbidity and mortality.
