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National Trends in Adrenalectomy for Neoplastic Disease, 1998-2004
Elan R Witkowski, Theodore P McDade, Joshua S Hill, James T McPhee, Giles F Whalen, Mary E Sullivan, Demetrius E Litwin, Jennifer F Tseng
University of Massachusetts Medical School, Worcester, MA
Objective: To assess changing patterns in the utilization and outcomes of adrenalectomy for neoplastic disease using a large national database.
Design: Retrospective observational study.
Setting: The Nationwide Inpatient Sample, 1998-2004.
Patients: 5,310 adult patients (@26,171 nationally by weighted analysis) who underwent adrenalectomy for neoplasm were identified using discharge ICD-9-CM codes.
Interventions: None.
Main Outcome Measures: Annual incidence of adrenalectomy, utilization of laparoscopy, in-hospital mortality and postoperative length of stay.
Results: 5,310 patients underwent adrenalectomy for neoplasm from 1998-2004. Adrenalectomies for all neoplasms increased by 90.1% (p<0.0003), while the ratio of benign to malignant disease remained stable over the same period. Among all adrenalectomies, 813 (15.5%) included abdominal laparoscopy. Rates of laparoscopy increased significantly from 8.8% in 1998 to 20.9% in 2004 by trend analysis (p<0.0001). Crude mortality was lower among patients undergoing laparoscopy (0.4% vs. 1.2%, p<0.0394); however, multivariate analysis demonstrated no significant mortality difference between the open and laparoscopic groups. Mean postoperative length of stay was shorter in laparoscopic cases (3.1 days vs. 5.5, p<0.0001). Diagnosis and advanced age were independently predictive of mortality (primary malignancy vs. benign neoplasm, O.R. 6.58 (95% C.I. 2.85-15.22); metastatic vs. benign, O.R. 3.27 (95% C.I. 1.19-8.99); ≥70 years vs. <60, O.R. 2.56 (95% C.I. 1.03-6.34)). There was no change in annual in-hospital mortality over the course of the study.
Conclusions: This large observational study demonstrates increased utilization of adrenalectomy nationwide 1998-2004, with a marked rise in cases utilizing laparoscopy. There was no change in the proportion of adrenalectomies performed for benign versus malignant neoplasms. Laparoscopic and open approaches did not demonstrate any differences in in-hospital mortality; however, laparoscopy was associated with a significantly shorter postoperative length of stay.
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