To evaluate the association of gynecologic surgeon experience with peri-operative complications of hysterectomy.

Design:

Retrospective cohort study. Exposure was year of experience at time of surgery; outcome was peri-operative complications.

Setting:

Tertiary academic medical center

Patients or Participants:

Patients undergoing abdominal hysterectomy, vaginal hysterectomy, and laparoscopic hysterectomy were identified by Current Procedural Terminology (CPT) Codes from January 1, 2017 to December 31, 2021. Patients in which the hysterectomy was performed by non-gynecologic surgeons, for obstetric reasons, and during pelvic exenteration were excluded.

Interventions:

Patients were compared with respect to surgeon year of experience and peri-operative complication rates. Multivariate logistic regression was performed; complications were considered as a composite, minor, and major according to Clavien-Dindo (CD) classification.

Measurements and Main Results:

We identified 25 gynecologic surgeons that performed 2,711 hysterectomies with or without concomitant procedures. An ROC curve analysis was used to evaluate the impact of surgeon year of experience on complications based on CD classifications. 16-year experience was identified as a discriminatory threshold for composite and minor (CD I-II) complications. Surgeons with >16 years experience had higher rates of composite (36.6% vs 31.4% p=0.0049) and minor complications (29.4% vs 22.2% p<0.001). Years of experience did not have a significant association with major complications (CD III-V), (7.2% vs. 9.3%, p=0.0496).

Surgeons with < 16 years experience performed a greater percentage of laparoscopic hysterectomies compared to surgeons with >16 years experience (57.8% v. 28.6%, p<0.001). Surgeons with >16 years experience performed more abdominal (32.7%) and transvaginal (38.8%).

Conclusion:

Fewer surgeon years of experience is not associated with an increase in major peri-operative complications. Our study also reflects the rise in minimally invasive approach for hysterectomy in surgeons in early years in practice.