Adrenalectomy: should urologists not be doing more?

Autor: Fuletra JG; Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA., Schilling AL; Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA., Canter D; Department of Urology, Ochsner Health System, New Orleans, LA, USA., Hollenbeak CS; Department of Health Policy and Administration, The Pennsylvania State University, State College, PA, USA., Raman JD; Division of Urology, Department of Surgery, Penn State Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA. jraman@pennstatehealth.psu.edu.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2020 Feb; Vol. 52 (2), pp. 197-204. Date of Electronic Publication: 2019 Oct 08.
DOI: 10.1007/s11255-019-02306-y
Abstrakt: Purpose: Adrenalectomy is an operation performed by both urologists and general surgeons; however, the majority are performed by general surgeons. We investigated whether there was a difference in outcomes based on surgical specialty performing the procedure. If no differences exist, an argument can be made that urologists should be doing more adrenalectomies.
Methods: The National Surgical Quality Improvement Project (NSQIP) Participant Use File (PUF) was queried to extract all cases of adrenalectomies performed from 2011 to 2015. Current Procedural Technology (CPT) codes 60540 and 60650 were used. The data were stratified by surgical specialty performing the adrenalectomy (urology or general surgery). Our outcomes of interest included post-surgical complications, reoperations, 30-day readmission, mortality, and hospital length of stay.
Results: A total of 3358 patients who underwent adrenalectomy between 2011 and 2015 were included. General surgeons performed 90% of these (n = 3012) and urologists performed 10% (n = 334). Differences in number of post-surgical complications, length of stay, rate of reoperation, 30-day readmission, and mortality were not statistically significant between general surgeons and urologists (p = 0.76, p = 0.29, p = 0.37, p = 0.98, and p = 0.59, respectively). Small complication rates disallowed multivariable analyses, but unadjusted rates for reoperation, presence of any post-operative complication, readmission within 30 days, and mortality were similar between specialties.
Conclusions: Surgical specialty did not make a difference in outcomes for patients undergoing adrenalectomy, despite a large disparity in the number of procedures performed by general surgeons versus urologists. Urologists should continue performing adrenalectomies and, given their familiarity with the retroperitoneum, perhaps perform more than is the current trend.
Databáze: MEDLINE
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