Outcomes From 3144 Adrenalectomies in the United States

Park, Henry S.

doi:10.1001/archsurg.2009.191

Cited by 183 publications

(60 citation statements)

References 36 publications

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“…2–5 Previous studies have demonstrated that increased surgical volume is an independent predictor of lower rates of postoperative complications and shorter length of stay for patients undergoing adrenalectomy in the United States and Spain. 18,19 Furthermore, greater surgical experience has been associated with improved oncologic outcomes for patients with ACC. For example, Kerkhofs et al evaluated patients with stage I to III ACC followed in the National Cancer Registry in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

et al. 2014

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Background Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume. Methods Patients with ACC were identified from the National Cancer Database (1998–2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs). Results A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05). There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)]. Conclusions Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.

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Section: Discussionmentioning

confidence: 99%

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

et al. 2014

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“…This is a potential source of selection bias because large and academic institutions are over-represented. However, there is evidence that a significant proportion of complex cases are performed by ACS-NSQIP institutions and that up to two thirds of adrenalectomies are performed at teaching hospitals, which suggests that this database likely captures a large numbers of adrenalectomies performed nationally 17, 18 . A significant limitation is the failure of ICD-9 codes to adequately identify the principal diagnosis of patients undergoing adrenalectomy.…”

Section: Discussionmentioning

confidence: 99%

Adrenalectomy Outcomes Are Superior with the Participation of Residents and Fellows

Seib

Greenblatt

Campbell

et al. 2014

Journal of the American College of Surgeons

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Background Adrenalectomy is a complex procedure performed in many settings, with and without residents and fellows. Patients often ask, "Will trainees be participating in my operation?" and seek reassurance that their care will not be adversely affected. The purpose of this study was to determine the association between trainee participation and adrenalectomy perioperative outcomes. Study Design We performed a cohort study of patients who underwent adrenalectomy from the 2005 to 2011 ACS-NSQIP database. Trainee participation was classified as none, resident, or fellow based on postgraduate year of the assisting surgeon. Associations between trainee participation and outcomes were determined via multivariate linear and logistic regression. Results Of 3694 adrenalectomies, 732 (19.8%) were performed by an attending surgeon with no trainee, 2315 (62.7%) involved a resident, and 647 (17.5%) involved a fellow. The participation of fellows was associated with fewer serious complications (7.9% with no trainee, 6.0% with residents, 2.8% with fellows, p<0.001). In a multivariate model, the odds of serious 30-day morbidity were lower when attending surgeons operated with residents (OR 0.63, 95% CI 0.45 to 0.89). Fellow participation was associated with significantly lower odds of overall (OR 0.51, 95% CI 0.32 to 0.82) and serious (OR 0.31, 95% CI 0.17 to 0.57) morbidity. There was no significant association between trainee participation and 30-day mortality. Conclusions In this analysis of multi-institutional data, the participation of residents and fellows was associated with decreased odds of perioperative adrenalectomy complications. Attending surgeons performing adrenalectomies with trainee assistance should reassure patients of the equivalent or superior care they are receiving.

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“…Although obesity is often considered a risk factor for postoperative complications, various studies conclude contradictory results [10,11]. LA presents lower rates of complications and mortalities than conventional open surgery, and surgeons' experience would further help to improve perioperative outcomes [12,13]. To our knowledge, convincing evidence for the impact of obesity on LA has not been acquired.…”

Section: Introductionmentioning

confidence: 99%

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Hang

Ho³

et al. 2015

Urol Int

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Introduction: Obesity is usually considered a risk factor for postoperative complications; however, previous studies conclude contradictory results in retroperitoneal laparoscopic adrenalectomy (LA). We aim to evaluate the impact of obesity on the perioperative outcomes of LA. Methods: A retrospective cohort study from a single center including 353 patients from 2011 to 2013 was conducted. Perioperative outcomes of patients from different groups were compared according to their body mass index (BMI). Results: All the patients were divided into 3 groups: normal (n = 149), overweight (n = 141) and obese (n = 63). Operative time (OT) for patients belonging to the obese group was significantly longer than that in the normal and overweight group, and the results of estimated blood loss, postoperative length of stay in hospital and postoperative complications were all similar. In the multivariate logistic regression analysis, OT was an independent risk factor for postoperative complications (odds ratio 1.020; 95% confidence interval 1.001-1.039; p = 0.037), while other factors including BMI had negligible effect. Conclusions: Retroperitoneal LA offers similar perioperative outcomes for patients with different obesity statuses, which could be safe and feasible for obese patients.

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Outcomes From 3144 Adrenalectomies in the United States

Abstract: To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.

Cited by 183 publications

References 36 publications

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

Treatment Patterns and Outcomes for Patients with Adrenocortical Carcinoma Associated with Hospital Case Volume in the United States

Adrenalectomy Outcomes Are Superior with the Participation of Residents and Fellows

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

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