Volume-outcome relationship in adrenal surgery from 2009-2017 in Germany-a retrospective study.

Autor:	Uttinger KL; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany.; Department of Visceral, Transplant, Thoracic and Vascular Surgery at Leipzig University Hospital, 04103 Leipzig, Germany., Reibetanz J; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Diers J; Department of Internal Medicne, Marienkrankenhaus, 22087 Hamburg, Germany., Baum P; Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, 62196 Heidelberg, Germany., Pietryga S; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Hendricks A; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Schütze L; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Baumann N; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Wiegering V; Department of Pediatrics, Ped. Hematology, Oncology and Stem Cell Transplantation, at Würzburg University Hospital, 97080 Würzburg, Germany., Lock J; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Dischinger U; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany., Seyfried F; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany., Fassnacht M; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, 97080 Würzburg, Germany.; Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, 97080 Würzburg, Germany., Germer CT; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany.; Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, 97080 Würzburg, Germany., Wiegering A; Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, 97080 Würzburg, Germany.; Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, 97080 Würzburg, Germany.; Department of Biochemistry and Molecular Biology, University of Würzburg, 97080 Würzburg, Germany.
Jazyk:	angličtina
Zdroj:	European journal of endocrinology [Eur J Endocrinol] 2023 Jan 10; Vol. 188 (1).
DOI:	10.1093/ejendo/lvac013
Abstrakt:	Objective: Adrenal resections are rare procedures of a heterogeneous nature. While recent European guidelines advocate a minimum annual caseload for adrenalectomies (6 per surgeon), evidence for a volume-outcome relationship for this surgery remains limited. Design: A retrospective analysis of all adrenal resections in Germany between 2009 and 2017 using hospital billing data was performed. Hospitals were grouped into three tertiles of approximately equal patient volume. Methods: Descriptive, univariate, and multivariate analyses were applied to identify a possible volume-outcome relationship (complications, complication management, and mortality). Results: Around 17 040 primary adrenal resections were included. Benign adrenal tumors (n = 8,213, 48.2%) and adrenal metastases of extra-adrenal malignancies (n = 3582, 21.0%) were the most common diagnoses. Six hundred and thirty-two low-volume hospitals performed an equal number of resections as 23 high-volume hospitals (median surgeries/hospital/year 3 versus 31, P < .001). Complications were less frequent in high-volume hospitals (23.1% in low-volume hospitals versus 17.3% in high-volume hospitals, P < .001). The most common complication was bleeding in 2027 cases (11.9%) with a mortality of 4.6% (94 patients). Overall in-house mortality was 0.7% (n = 126). Age, malignancy, an accompanying resection, complications, and open surgery were associated with in-house mortality. In univariate analysis, surgery in high-volume hospitals was associated with lower mortality (OR: 0.47, P < .001). In a multivariate model, the tendency remained equal (OR: 0.59, P = .104). Regarding failure to rescue (death in case of complications), there was a trend toward lower mortality in high-volume hospitals. Conclusions: The annual caseload of adrenal resections varies considerably among German hospitals. Our findings suggest that surgery in high-volume centers is advantageous for patient outcomes although fatal complications are rare. Competing Interests: Conflicts of interest: None declared. (© The Author(s) 2023. Published by Oxford University Press on behalf of (ESE) European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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