Impact of hospital surgical volume on in-hospital outcomes of peripartum hysterectomy: A nationwide retrospective cohort study.

Objective: This study was performed to evaluate the association between hospital surgical volume and in-hospital outcomes among patients undergoing peripartum hysterectomy in Japan.

Methods: A retrospective cohort study was conducted using data from the Diagnostic Procedure Combination database from July 2010 to March 2022. Patients who underwent peripartum hysterectomy were identified, and hospitals were categorized into low-, medium-, and high-volume groups based on annual surgical volume. Multivariable analyses, adjusted for patient- and hospital-level variables, were performed to assess associations between surgical volume and in-hospital outcomes, including maternal death, reoperation, surgical complications, transfusion volumes, operative time, and length of postoperative stay. A subgroup analysis was conducted focusing on patients with placenta accreta spectrum.

Results: In total, 2819 patients were included in the final cohort. The high-volume group had a higher prevalence of placenta previa and placenta accreta spectrum, while the low-volume group had more cases of uterine rupture. After multivariable adjustment, no significant differences were found in all in-hospital outcomes. In the subgroup analysis, longer operative times were observed in the high-volume group for patients with placenta accreta spectrum than in the low-volume group, but no other significant differences in outcomes were detected.

Conclusion: Hospital surgical volume was not found to be significantly associated with in-hospital outcomes for peripartum hysterectomy. This result indicates that the perinatal healthcare system in Japan may contribute to maintaining consistent care quality across various institutions.