Impact of Minimally Invasive Gynecology Fellowship Training on Patient Outcomes for Hysterectomy Procedures

Study Objective Evaluate differences in patient outcomes for hysterectomies performed by Fellowship-trained surgeons compared to Generalists. Design Retrospective review. Setting 5 Toronto hospitals. Patients or Participants Patients undergoing hysterectomy from July 2016-June 2018. Interventions Patient outcomes for surgeons with 6 months (minimum) of fellowship training in minimally invasive gynecology (Fellowship) were compared to those without post-residency training (Generalist). Hysterectomies performed by urogynecologists were excluded. Measurements and Main Results Primary outcome was complications (in-hospital and within 30-days of discharge). Secondary outcomes were grade of complication, return to emergency room (ER), surgeon case volume. Binary logistic regression analysis was performed comparing hysterectomies by Fellowship versus Generalist surgeons controlling for factors associated with case complexity. Odds ratios (OR), 95% confidence intervals (CI) and p-values were calculated. 1379 hysterectomies were included (702 cases by 17 Fellowship surgeons and 677 cases by 41 Generalists). Fellowship cases were more likely to have endometriosis (19.9% vs. 7.9%, p Conclusion There was no difference in complications for hysterectomies performed by Fellowship compared to Generalist surgeons. Fellowship surgeons had greater technicity rate. Cases performed by Fellowship surgeons were more complex with higher chance of additional procedures.