Surgeon Volume: A Small but Significant Disparity Predictor

This study examined whether the volume of hysterectomies performed by a surgeon influences the relationship between a patient’s race and the type of surgical procedure they receive for benign conditions—either minimally invasive surgery (MIS) or open abdominal surgery.

Hysterectomy is a common gynecologic procedure, but racial disparities persist in access to minimally invasive surgery, which offers benefits such as shorter hospital stays, less pain, and faster recovery compared to open abdominal surgery. Black patients are disproportionately likely to undergo an abdominal hysterectomy, which may negatively impact their outcomes. Understanding the role of surgeon experience in these disparities, measured by annual case volume, could inform strategies to improve equity in surgical care.

The researchers conducted a retrospective analysis using data from the Premier Healthcare Database, which includes hospital admissions and outpatient encounters across the United States. They analyzed records of 367,593 adult women (18 years or older) who underwent an hysterectomy for benign conditions between 2016 and 2023. Surgeon volume was categorized as low (seven or fewer cases annually) or nonlow (eight or more cases annually). Statistical models were used to evaluate the relationships between race, surgeon volume, and surgical approach.

Black patients were 46% more likely than White patients to be treated by low-volume surgeons. Patients treated by low-volume surgeons had over twice the odds of undergoing open abdominal surgery compared to those treated by nonlow-volume surgeons. While surgeon volume significantly influenced the relationship between race and surgical approach, it explained only 2.7% to 3.1% of the observed disparity, suggesting that other factors also contribute to these inequities.

These findings highlight surgeon volume as a small but measurable factor in racial disparities in hysterectomy approach. Interventions to improve access to high-volume surgeons, such as strengthening referral pathways, expanding minimally invasive surgical training, and increasing resources in hospitals serving marginalized populations, could all help address inequities and improve outcomes for Black patients undergoing an hysterectomy.

The authors recommend further research to explore additional factors contributing to racial disparities in surgical technique, including institutional practices, patient preferences, and geographic barriers. They also emphasize the need for policies and programs that expand access to minimally invasive surgery for underserved populations.

This research was supported by Intuitive Surgical to access the de-identified hospital-based, service-level data from the Premier Healthcare Database. Yale University also provided funding and support.