2008 Annual Meeting Abstracts
Outcomes From 3,144 Adrenalectomies in the U.S.: Which Matters More, Surgeon Volume or Specialty?
Henry S. Park, B.S., Sanziana A. Roman, M.D., Leon Boudourakis, B.S., Daniel C. Thomas, B.S., Julie Ann Sosa, M.D..
Yale University School of Medicine, New Haven, CT, USA.
Objective: To assess the effect of surgeon specialty and volume on clinical and economic outcomes following adrenalectomy.
Design: Population-based retrospective cohort analysis.
Setting: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of U.S. non-federal hospitals.
Patients/Providers: Adults (>=18 years) undergoing adrenalectomy in the U.S., 1999-2005. Patient demographic/clinical characteristics, surgeon specialty (general surgeon vs. urologist), surgeon volume of adrenalectomies, and hospital factors were measured.
Intervention: Statistical analyses with chi-square, ANOVA, multivariate linear/logistic regression.
Main Outcome Measures: In-hospital complications, mean length of hospital stay (LOS).
Results: 3,144 adrenalectomies were performed. Mean patient age was 54 years; 59% were women, and 64% white. Benign neoplasms comprised 60% of primary diagnoses, and unilateral adrenalectomies 89% of primary procedures. A higher proportion of general surgeons were high-volume compared with urologists (34 vs. 18%, p<0.001). Compared with low-volume surgeons, high-volume surgeons used more laparoscopy (23 vs. 11%, p<0.001), and operated at teaching (94 vs. 56%, p<0.001) and high-volume hospitals (54 vs. 10%, p<0.001). Low-volume surgeons had more complications (18 vs. 11% p<0.001) and longer LOS (5.5 vs. 3.9 days, p<0.001) than high-volume surgeons, and urologists had more complications (18 vs. 15%, p<0.05) than general surgeons. After adjustment for patient/provider characteristics in multivariate analyses, surgeon volume (OR=1.6, p=0.001), not specialty (OR=1.2, p=NS), was an independent predictor of complications. Hospital volume was not associated with complications. For LOS, only surgeon volume (difference of 1 day, p<0.001) was a predictor.
Conclusions: Surgeon volume, not specialty, was an independent predictor of complications and LOS following adult adrenalectomy. In order to optimize outcomes, patients with adrenal disease should be referred to surgeons based on their volume of adrenalectomies, irrespective of their specialty practice.