Trends in Volume of Benign Hysterectomies Performed by Gynecologic Oncologists, 2015-2021: A National Surgical Quality Improvement Project Analysis.

Objective: To evaluate national trends in the surgical volume of benign hysterectomies, and trends in percentage of benign hysterectomies performed by gynecologic oncologists (GOs) in the United States through analysis of National Surgical Quality Improvement Program (NSQIP) database. The study secondarily sought to evaluate if any clinical patient factors accounted for differences in type of surgeon sub-specialization. The study hypothesized that in alignment with self-reported GO surveys, GOs were performing an increasing volume of benign hysterectomies annually.

Design: Observational retrospective analysis.

Setting: National Participants: NSQIP participants Interventions: This observational study queried the NSQIP database for the total number of hysterectomies performed from 2015-2021 in the United States, with attention to surgeon sub-specialization, the pathology-proven presence of malignancy, and factors that may influence the surgical complexity of the case including history of abdominal/pelvic surgeries, presence of intraoperative endometriosis, and uterine weight in grams. Statistical analysis was performed using SAS 9.4 (SAS Institute, Cary, NC) and SPSS (29.0.2.0(20).

Results: The volume of all hysterectomies in the United States increased from 2015-2021 in this sample. The overall increase in benign hysterectomies was statistically significant, with an annual percentage multiplier (APM) of 1.003% (95% CI 1.001-1.006) per year. GOs performed an increasing share of the total number of benign hysterectomies with an APM of 1.026% per year (95% CI 1.02-1.03). GOs were more likely to perform benign hysterectomies in patients with a history of prior abdominal surgery (p<0.001) and in uterine weights >500g (p<0.001). No difference was observed in surgeon sub-specialization in patients with a prior history of pelvic surgery (p=0.10) or presence of intra-operative endometriosis (p=0.10).

Conclusions: The overall volume of benign hysterectomies in the United States is increasing, based on NSQIP data between 2015-2021. This analysis demonstrates that GOs are performing significantly increasing volumes and proportions of benign hysterectomies compared to the overall national increase in cases within this cohort.