The effect of physician experience on costs and clinical outcomes of laparoscopic-assisted vaginal hysterectomy: a multivariate analysis

STUDY OBJECTIVE: To evaluate whether or not a physician's experience has an effect on costs and clinical outcomes of an implemented clinical pathway for laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred twenty women. INTERVENTION: LAVHs, 84 performed by senior physicians and 36 by junior physicians. MEASUREMENTS AND MAIN RESULTS: According to results of multiple linear regression analysis, after controlling for other independent variables, senior attending physicians, each with over 6 years of experience, managed to reduce all costs related to LAVH, operating time, and length of stay. Logistic regression analysis revealed no differences in the occurrence of intravenous fluid injection, antibiotic injection more than 2 days after surgery, and complications between physicians with and those without experience. Neither group had blood transfusions, patient mortality, or readmissions within 2 weeks of discharge. CONCLUSION: Physician experience reduces medical costs and maintains the quality of care in LAVH. We suggest regular training courses for less-experienced physicians in order to contain costs and maintain quality of care under the quota case-payment system.