Top

Annals of Surgical Oncology

Published in:

01-01-2015 | Endocrine Tumors

Factors Associated with Higher Risk of Complications After Adrenal Surgery

Authors: Adam Hauch, MD, MBA, Zaid Al-Qurayshi, MBChB, MPH, Emad Kandil, MD, FACS

Published in: Annals of Surgical Oncology | Issue 1/2015

Abstract

Background

Surgeon experience has been demonstrated to result in better outcomes after a variety of advanced operations. Less information is available regarding adrenal surgery. We compared the outcomes after adrenalectomy for a variety of indications and determined the effect of surgeon’s case volume.

Methods

Cross-sectional analysis was performed using ICD-9 procedure codes included in the Nationwide Inpatient Sample from 2003 to 2009 to identify all adult patients who underwent unilateral or bilateral adrenalectomy for benign or malignant conditions. Logistic regression was used to test for interaction between surgeon case volume (low = 1, intermediate = 2–5, and high = >5 adrenalectomies per year), diagnosis, type of operation performed, and risk of complications.

Results

A total of 7,829 adrenalectomies were included. Risk of complications after bilateral adrenalectomy was 23.4 % compared to 15.0 % for unilateral adrenalectomy (odds ratio 2.165, 95 % confidence interval 1.335, 3.512). Malignancy was associated with higher risk of complication (23.1 %) than benign disease (13.2 %) (odds ratio 1.685, 95 % confidence interval 1.371, 2.072). Complication rates for low- and intermediate-volume surgeons were 18.8 and 14.6 %, respectively, and both were significantly higher than complications by high-volume surgeons (11.6 %, p < 0.05). Length of stay and charges were both significantly less for high-volume surgeons compared to lower-volume groups (p < 0.05).

Conclusions

Low surgeon case volumes and adrenal surgery for malignant or bilateral disease are associated with increased risk of postoperative complications. Length of stay and charges were significantly less when high-volume surgeons perform adrenal surgery.

Saunders BD, Wainess RM, Dimick JB, Upchurch GR, Doherty GM, Gauger PG. Trends in utilization of adrenalectomy in the United States: have indications changed? World J Surg. 2004;28:1169–75.PubMedCrossRef

Abecassis M, McLoughlin MJ, Langer B, Kudlow JE. Serendipitous adrenal masses: prevalence, significance, and management. Am J Surg. 1985;149:783–8.PubMedCrossRef

Bovio S, Cataldi A, Reimondo G, et al. Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. J Endocrinol Invest. 2006;29:298–302.PubMedCrossRef

Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190:1163–8.PubMedCrossRef

Saunders BD, Wainess RM, Dimick JB, Doherty GM, Upchurch GR, Gauger PG. Who performs endocrine operations in the United States? Surgery. 2003;134:924–31.PubMedCrossRef

Chen H, Zeiger MA, Gordon TA, Udelsman R. Parathyroidectomy in Maryland: effects of an endocrine center. Surgery. 1996;120:948–53.PubMedCrossRef

Zelen J, Bilfinger TV, Anagnostopoulos CE. Coronary artery bypass grafting: the relationship of surgical volume, hospital location, and outcome. NY State J Med. 1991;91:290–2.

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.PubMedCrossRef

Dimick JB, Cowan JA Jr, Stanley JC, Henke PK, Pronovost PJ, Upchurch GR Jr. Surgeon specialty and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States. J Vasc Surg. 2003;38:739–44.PubMedCrossRef

10.

Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3 years summary. Surgery. 2003;134:613–23.PubMedCrossRef

11.

Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240:586–94.PubMedCentralPubMed

12.

Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg. 2003;237:509–14.PubMedCentralPubMed

13.

Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228:429–38.PubMedCentralPubMedCrossRef

14.

Casson AG, Van Lanschot JJ. Improving outcomes after esophagectomy: the impact of operative volume. J Surg Oncol. 2005;92:262–6.PubMedCrossRef

15.

Wang T. Endocrine surgery. Am J Surg. 2011;202:369–71.PubMedCrossRef

16.

Park HS, Roman SA, Sosa JA. Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty? Arch Surg. 2009;144:1060–7.PubMedCrossRef

17.

HCUP Databases. Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville. 2014. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 7 Feb 2014.

18.

Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007;142:887–99.PubMedCrossRef

19.

Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9CM and ICD-10 administrative data. Med Care. 2005;43:1130–9.PubMedCrossRef

20.

Gallagher SF, Wahi M, Haines KL, et al. Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1816 adrenalectomies. Surgery. 2007;142:1011–21.PubMedCrossRef

21.

Harness JK, Organ CH Jr, Thompson NW. Operative experience of US general surgery residents with diseases of the adrenal glands, endocrine pancreas, and other less common endocrine organs. World J Surg. 1996;20:885–90.PubMedCrossRef

22.

Le D, Karmali S, Harness JK, Sheppard BC. An update: the operative experience in adrenal, pancreatic, and other less common endocrine diseases of US general surgery residents. World J Surg. 2008;32:232–6.PubMedCrossRef

23.

Quan H, Li B, Saunders LD, et al. Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. Health Serv Res. 2008;43:1424–41.PubMedCentralPubMedCrossRef

Title: Factors Associated with Higher Risk of Complications After Adrenal Surgery
Authors: Adam Hauch, MD, MBA
Zaid Al-Qurayshi, MBChB, MPH
Emad Kandil, MD, FACS
Publication date: 01-01-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3750-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors Associated with Higher Risk of Complications After Adrenal Surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Less Remains Better: Morbidity After Axillary Surgery

Survival Outcomes of Metaplastic Breast Cancer Patients: Results from a US Population-based Analysis

Impact of 68Ga-DOTATATE PET/CT on the Surgical Management of Primary Neuroendocrine Tumors of the Pancreas or Ileum

Sphincter Preservation Rates After Radical Resection for Rectal Cancer in the United States Veteran Population: Opportunity for Improvement in Early Disease

Yes, Breast Surgeons May Provide Breast Cancer Genetic Assessment and Testing

The Utility of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Suspicious for Microinvasion on Core Biopsy