Design: Retrospective review of claims data

Setting: Community Hospitals

Patients or Participants: Single FMIGS graduate surgeon’s surgical practice

Interventions:

A single FMIGS graduate’s deidentified administrative data was used to characterize growth of a new community-based complex benign gynecologic surgical practice in the first 4 years (August 2017-August 2021) after Fellowship.

Date of Service (DoS), Place of Service (PoS), CPT codes, modifiers (M##) and ICD-10-PCS codes were aggregated from hospital and outpatient sources.

Measurements and Main Results:

During the study period, the surgeon coded 1,884 new patient consults resulting in 814 major and minor cases as primary surgeon, rising from 124 in the first year to a peak of 264 in year 3. Hysterectomies comprised 24.2% (197/819) of cases. Total vaginal hysterectomy (39.1%, 77/197) and total laparoscopic hysterectomy (39.6%, 78/197) were most common. Despite adoption of vNOTES, vaginal hysterectomy volumes declined as the surgeon reported a subjective shift in practice toward endometriosis/pelvic pain.

Operative laparoscopies numbered 154 for complex benign adnexal pathology and 17 laparoscopic myomectomies. Non-opportunistic elective sterilization was referred out due to employer ethical and religious directives. Hysteroscopy included 232 hospital procedures, with 21 hysteroscopic myomectomies, 31 endometrial ablations and 6 lysis of adhesion.

Surgical management of pelvic floor disorders comprised 251 total codes as primary surgeon. This included 63 uterosacral suspensions (25.1%, n=251), 18 sacrocolpopexies, 96 anterior and/or posterior repairs, 25 colpocleisis and 32 midurethral slings.

M78 (unplanned return to OR within global period) was found on 3 distinct DoS. One vaginal cuff dehiscence, one I&D, one apparent same-day return to OR for vaginal hematoma after colporraphy were identified.

Conclusion: FMIGS training can immediately deliver independent, high-volume gynecologic surgeons to clinical practice. Graduates can provide a diverse and flexible range of surgical interventions to comprehensively manage the full spectrum of complex benign gynecologic conditions within community settings.