From the Research
A high volume center for cesarean hysterectomies is generally considered one that performs at least 25 procedures annually, as this threshold is associated with a 22% decreased risk of surgical complications compared to low-volume centers. This distinction is important because higher procedural volume is associated with better patient outcomes, including lower mortality rates, fewer complications, and shorter hospital stays. The improved outcomes at high volume centers likely result from the surgical team's greater experience and expertise with this complex emergency procedure, better systems for managing massive hemorrhage, more efficient interdisciplinary communication, and greater availability of blood products and specialized equipment 1. According to a systematic review, delivery at a hospital with high cesarean hysterectomy volume is a level B recommendation, indicating that the evidence is consistent and strong enough to support this guideline 2. Institutions performing fewer cesarean hysterectomies may benefit from simulation training, standardized protocols, and consultation with high volume centers to maintain competency despite lower case numbers. When possible, patients at high risk for peripartum hemorrhage requiring possible hysterectomy should be referred to high volume centers for delivery. Key factors that contribute to the improved outcomes at high volume centers include:
- Greater experience and expertise with the procedure
- Better systems for managing massive hemorrhage
- More efficient interdisciplinary communication
- Greater availability of blood products and specialized equipment It is essential to note that the definition of a high volume center may vary depending on the specific context and population, but the threshold of 25 procedures annually is supported by the most recent and highest quality evidence 1.