Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?

Table 1 Patient demographics-subspecialty, n (%)

	General gynecologist, n = 255; mean ± SD	Urogynecologist, n = 196; mean ± SD	Gynecologic oncologist, n = 102; mean ± SD	P value
Age (yr)	45.4 ± 8.3	58.9 ± 12.5	55.9 ± 11.3	< 0.0001
Race				0.001
Black	94 (37)	42 (21)	19 (18)
White	146 (57)	139 (71)	73 (72)
Other/Unknown	15 (6)	15 (8)	10 (10)
BMI	32.6 ± 7.7	29.2 ± 6.3	34.4 ± 9.2	< 0.0001a
Cardiovascular disease	41 (16)	70 (36)	27 (27)	< 0.0001
Hypertension	83 (33)	86 (44)	48 (47)	0.01
Diabetes mellitus	25 (10)	24 (12)	18 (18)	0.12
Chronic lung disease	44 (17)	27 (14)	16 (16)	0.62
History of abdominal surgery	160 (63)	109 (56)	55 (54)	0.18

^aUrogynecologist vs general gynecologist and gynecologic oncologist, P < 0.0001, general gynecologist vs gynecological oncologist, P = 0.12. BMI: Body mass index.

Table 2 Surgery characteristics and length of stay-subspecialty

	General gynecologist, n = 255; mean ± SD or median (25th %ile, 75th %ile)	Urogynecologist, n = 196; mean ± SD or median (25th %ile, 75th %ile)	Gynecologic oncologist, n = 102; mean ± SD median (25th %ile, 75th %ile)	P value
Total set-up time (minutes)	34.3 ± 8.2	51.1 ± 7.7	40.7 ± 9.8	< 0.0001a
Total operating time (minutes)	133.1 ± 57.8	257.8 ± 48.9	162.4 ± 69.2	< 0.0001a
Total room time (minutes)	192.1 ± 61.5	343.0 ± 51.9	231.1 ± 74.5	< 0.0001a
Uterine weight (grams)	181.2 ± 131.1	104.1 ± 72.7	150.9 ± 104.3	< 0.0001b
Estimated blood loss (mL)	100.0 (50, 200)	25.0 (20, 50)	50.0 (50, 100)	< 0.0001
Length of stay (d)	1.0 ± 0.7	1.1 ± 0.2	1.0 ± 0.5	0.93

^aAll comparisons, P < 0.0001.

^bGeneral gynecologist vs urogynecologist, P < 0.0001; general gynecologist vs gynecological oncologist, P = 0.06; urogynecologist vs gynecological oncologist, P = 0.002.

Table 3 Surgery type and concomitant procedures-subspecialty, n (%)

	General gynecologist, n = 255	Urogynecologist, n = 196	Gynecologic oncologist, n = 102	P value
Surgery				--
LAVH	144 (57)	0 (0)	25 (24)
LSH	13 (5)	0 (0)	1 (1)
TLH	47 (18)	0 (0)	13 (13)
RATLH	50 (20)	196 (100)	63 (62)
Concomitant procedures				--
None	19 (8)	0 (0)	1 (1)
BS	168 (66)	13 (7)	13 (13)
BSO	66 (26)	2 (10	88 (86)
BS+SC	0 (0)	34 (17)	0 (0)
BSO+SC	0 (0)	116 (59)	0 (0)
SC	0 (0)	3 (2)	0 (0)
BS+USLS	1 (0)	18 (9)	0 (0)
BSO+USLS	1 (0)	7 (3)	0 (0)
USLS	0 (0)	3 (2)	0 (0)
Rectopexy	2 (1)	31 (16)	0 (0)	--
Cystourethroscopy	105 (41)	194 (99)	30 (29)	< 0.0001
Lysis of adhesions	55 (22)	68 (35)	34 (34)	0.004
Uterolysis	2 (1)	11 (6)	2 (2)	0.01
Conversion to open	5 (2)	0 (0)	2 (2)	--

BS: Bilateral salpingectomy; BSO: Bilateral salpingo-oophorectomy; SC: Sacrocolpopexy; LAVH: Laparoscopic assisted vaginal hysterectomy; LSH: Laparoscopic supracervical hysterectomy; RATLH: Robotic-assisted laparoscopic hysterectomy; TLH: Total laparoscopic hysterectomy; USLS: Uterosacral ligament suspension.

Table 4 Patient demographics of high vs low-volume surgeons, n (%)

	High-volume, n = 280, mean ± SD	Low-volume, n = 273, mean ± SD	P value
Age (yr)	58.1 ± 12.3	46.0 ± 8.8	< 0.0001
Race
Black	60 (21)	93 (35)	0.002
White	197 (70)	161 (59)
Other/Unknown	23 (8)	17 (6)
BMI	30.9 ± 7.8	32.6 ± 7.8	0.01
Cardiovascular disease	92 (33)	46 (17)	< 0.0001
Hypertension	127 (45)	90 (33)	0.003
Diabetes mellitus	42 (15)	25 (9)	0.04
Chronic lung disease	41 (15)	46 (17)	0.49
History of abdominal surgery	153 (55)	171 (63)	0.06

BMI: Body mass index.

Table 5 Operating time of high vs low-volume surgeons

	High-volume, n = 280, mean ± SD	Low-volume, n = 273, mean ± SD	P value
Total set-up time (min)	47.5 ± 9.6	35.2 ± 9.3	< 0.0001
Total operating time (min)	224.4 ± 73.8	140.0 ± 62.7	< 0.0001
Total room time (min)	303.9 ± 82.1	200.3 ± 68.1	< 0.0001