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. 2024 Mar:229:44-49.
doi: 10.1016/j.amjsurg.2023.10.042. Epub 2023 Oct 23.

Adrenalectomy approach and outcomes according to surgeon volume

Sara P Ginzberg  1 , Julia A Gasior  2 , Lauren R Kelz  3 , Jesse E Passman  4 , Jacqueline M Soegaard Ballester  3 , Robert E Roses  2 , Douglas L Fraker  2 , Heather Wachtel  2
Affiliations

Adrenalectomy approach and outcomes according to surgeon volume

Sara P Ginzberg et al. Am J Surg. 2024 Mar.

Abstract

Background: This study assessed the relationship between surgeon volume, operative management, and resource utilization in adrenalectomy.

Methods: Isolated adrenalectomies performed within our health system were identified (2016-2021). High-volume surgeons were defined as those performing ≥6 cases/year. Outcomes included indication for surgery, perioperative outcomes, and costs.

Results: Of 476 adrenalectomies, high-volume surgeons (n ​= ​3) performed 394, while low-volume surgeons (n ​= ​12) performed 82. High-volume surgeons more frequently operated for pheochromocytoma (19% vs. 16%, p ​< ​0.001) and less frequently for metastasis (6.4% vs. 23%, p ​< ​0.001), more frequently used laparoscopy (95% vs. 80%, p ​< ​0.001), and had lower operative supply costs ($1387 vs. $1,636, p ​= ​0.037). Additionally, laparoscopic adrenalectomy was associated with shorter length of stay (-3.43 days, p ​< ​0.001), lower hospitalization costs (-$72,417, p ​< ​0.001), and increased likelihood of discharge to home (OR 17.03, p ​= ​0.008).

Conclusions: High-volume surgeons more often resect primary adrenal pathology and utilize laparoscopy. Laparoscopic adrenalectomy is, in turn, associated with decreased healthcare resource utilization.

Keywords: Adrenal metastasectomy; Adrenal neoplasms; Endocrine surgery; Length of stay; Minimally invasive surgery.

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Conflict of interest statement

Declaration of competing interest Sara P. Ginzberg, Julia A. Gasior, Lauren R. Kelz, Jesse E. Passman, Jacqueline M. Soegaard Ballester, Robert E. Roses, Douglas L. Fraker, and Heather Wachtel have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Total case volume of surgeons who performed isolated adrenalectomies, 2016–2021.
Surgeon case volume ranged from 1–229 over the study period. Three surgeons were categorized as high-volume, and 11 surgeons were categorized as low-volume.
Figure 2.
Figure 2.. Distribution of (A) operative supply costs and (B) total hospitalization charges, stratified by technical approach. * indicates p-value <0.01.
Laparoscopic adrenalectomies incurred lower median operative supply costs ($1,362 vs. $1,638) and lower total hospitalization charges ($74,531 vs. $122,407) compared to open adrenalectomies.
See this image and copyright information in PMC

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