Volume–outcome relationship in adrenal surgery from 2009-2017 in Germany—a retrospective study. Issue 1 (10th January 2023)

• Record Type: Journal Article
• Authors: Uttinger, Konstantin L; Reibetanz, Joachim; Diers, Johannes; Baum, Philip; Pietryga, Sebastian; Hendricks, Anne; Schütze, Leon; Baumann, Nikolas; Wiegering, Verena; Lock, Johann; Dischinger, Ulrich; Seyfried, Florian; Fassnacht, Martin; Germer, Christoph-Thomas; Wiegering, Armin
• Is Part Of: European journal of endocrinology. Volume 188:Issue 1(2023)
• Publication Date: 2023-01-10
• Subjects: adrenal surgery -- volume–outcome relationship -- secondary data analysis -- surgical quality -- minimally invasive procedure; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1093/ejendo/lvac013
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract: 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.