Monday, March 29, 2010

Trends in adrenalectomy: a recent national review

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Trends in adrenalectomy: a recent national review

Melissa M. Murphy1 Contact 
Information, Elan R. Witkowski1, Sing Chau Ng1, Theodore P. McDade1, Joshua S. Hill1, Anne C. Larkin1, Giles F. Whalen1, Demetrius E. Litwin1 and Jennifer F. Tseng1 Contact 
Information

(1)
Department of Surgery, Surgical Outcomes Analysis and Research (SOAR), University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA 01655, USA

Received: 20 May 2009  Accepted: 26 February 2010  Published online: 25 March 2010

Abstract

Background

Adrenalectomy remains the definitive therapy for most adrenal neoplasms. Introduced in the 1990s, laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality. This study aimed to evaluate national adrenalectomy trends, including major postoperative complications and perioperative mortality.

 

Methods

The Nationwide Inpatient Sample was queried to identify all adrenalectomies performed during 1998–2006. Univariate and multivariate logistic regression were performed, with adjustments for patient age, sex, comorbidities, indication, year of surgery, laparoscopy, hospital teaching status, and hospital volume. Annual incidence, major in-hospital postoperative complications, and in-hospital mortality were evaluated.

 

Results

Using weighted national estimate, 40,363 patients with a mean age of 54 years were identified. Men made up 40% of these patients, and 77% of the patients were white. The majority of adrenalectomies (83%) were performed for benign disease. The annual volume of adrenalectomies increased from 3,241 in 1998 to 5,323 in 2006 (p < 0.0001, trend analysis). The overall in-hospital mortality was 1.1%, with no significant change. Advanced age (<45 years as the referent; ≥65 years: adjusted odds ratio [AOR], 4.10; 95%; confidence Interval [CI], 1.66–10.10) and patient comorbidities (Charlson score 0 as the referent; Charlson score ≥2: AOR, 4.33; 96% CI, 2.34–8.02) were independent predictors of in-hospital mortality. Indication, year, hospital teaching status, and hospital volume did not independently affect perioperative mortality. Major postoperative in-hospital complications occurred in 7.2% of the cohort, with a significant increasing trend (1998–2000 [5.9%] vs 2004–2006 [8.1%]; p < 0.0001, trend analysis). Patient comorbidities (Charlson score 0 as the referent; Charlson score ≥2: AOR, 4.77; 95% CI, 3.71–6.14), recent year of surgery (1998–2000 as the referent; 2004–2006: AOR, 1.40; 95% CI, 1.09–1.78), and benign disease (malignant disease as the referent; benign disease: AOR, 1.98; 95% CI, 1.55–2.53) were predictive of major postoperative complications at multivariable analyses, whereas laparoscopy was protective (no laparoscopy as the referent; laparoscopy: AOR, 0.62; 95% CI, 0.47–0.82).

 

Conclusion

Adrenalectomy is increasingly performed nationwide for both benign and malignant indications. In this study, whereas perioperative mortality remained low, major postoperative complications increased significantly.

Keywords Adrenalectomy - Complications - Mortality - Nationwide inpatient sample


Contact 
Information
Melissa M. Murphy
Email: melissa.murphy-smith@umassmemorial.org

Contact 
Information
Jennifer F. Tseng (Corresponding author)
Email: Jennifer.Tseng@umassmemorial.org

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From http://www.springerlink.com/content/h2j69247138788u8/