Objective: Our purpose was to determine whether the rates of conversion to laparotomy and surgical complication rate decrease with increasing physician experience with laparoscopically assisted vaginal hysterectomies (LAVH) in a large population-based administrative database.
Study design: We queried the North Carolina Medical Commission Database for all LAVHs performed in the state from January 1, 1988, through September 30, 1994. Conversion to laparotomy and the surgical complication rate were analyzed by use of logistic regression controlling for patient age, socioeconomic level, academic setting, and indication for surgery. Physician experience was assessed by sequentially assigning case numbers for each LAVH by attending physician. A surgical complication was defined as any International Classification of Disease, 9th Revision, code for intraoperative organ injury, excessive blood loss, blood transfusion, or wound infection.
Results: Six hundred two attending physicians performed 3,728 LAVHs during the observation period. The median number of LAVHs performed by each attending physician was 2, range 1-107, mean 6.2 +/- 10.1. The mean age of the patients was 39.4 +/- 9.2 years. The mean number of days hospitalized was 2.8 +/- 1.6. A concurrent bilateral salpingo-oophorectomy was performed in 46.4% of the LAVHs. Only 1% were performed for malignancy. There was one reported death. A total of 10.3% of the patients were from a low socioeconomic level. Nine percent were performed at an academic center. Overall, there was a 21.5% rate of conversion to laparotomy and a 12.1% surgical complication rate. The rate of conversion to laparotomy significantly decreased with increasing physician experience (P <.0001) and retained its significance even after patient age, socioeconomic level, indication for surgery, academic setting, and surgical complication were controlled. However, no decrease in the surgical complication rate was observed with increasing physician experience.
Conclusion: As the number of LAVHs performed by an individual physician increases, the rate of conversion to laparotomy decreases. However, no significant increase or decrease in the complication rate was observed with increasing operator experience.