OBJECTIVE: To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy. DESIGN: Population-based retrospective cohort analysis. SETTING: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PARTICIPANTS: Adults (>or=18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed. MAIN OUTCOME MEASURES: The chi(2) test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs. RESULTS: A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-volume surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-volume surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13,168 vs $11,732, P = .02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital volume was associated only with LOS (0.8-day difference, P < .007). Surgeon volume, specialty, and hospital volume were not predictors of costs. CONCLUSION: To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.
OBJECTIVE: To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy. DESIGN: Population-based retrospective cohort analysis. SETTING: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PARTICIPANTS: Adults (>or=18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed. MAIN OUTCOME MEASURES: The chi(2) test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs. RESULTS: A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-volume surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-volume surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13,168 vs $11,732, P = .02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital volume was associated only with LOS (0.8-day difference, P < .007). Surgeon volume, specialty, and hospital volume were not predictors of costs. CONCLUSION: To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.
Authors: Sandra Sommerey; Yalda Foroghi; Costanza Chiapponi; Sebastian F Baumbach; Klaus K J Hallfeldt; Roland Ladurner; Julia K S Gallwas Journal: Langenbecks Arch Surg Date: 2015-02-27 Impact factor: 3.445
Authors: Celestino Pio Lombardi; Marco Raffaelli; Marco Boniardi; Giorgio De Toma; Luigi Antonio Marzano; Paolo Miccoli; Francesco Minni; Mario Morino; Maria Rosa Pelizzo; Andrea Pietrabissa; Andrea Renda; Andrea Valeri; Carmela De Crea; Rocco Bellantone Journal: Langenbecks Arch Surg Date: 2011-11-09 Impact factor: 3.445
Authors: Dimitrios Stefanidis; Melanie Goldfarb; Kent W Kercher; William W Hope; William Richardson; Robert D Fanelli Journal: Surg Endosc Date: 2013-09-10 Impact factor: 4.584
Authors: Nicholas C J Lee; Jacqueline R Kelly; Yi An; Henry S Park; Benjamin L Judson; Barbara A Burtness; Zain A Husain Journal: Cancer Date: 2019-02-12 Impact factor: 6.860
Authors: Cevher Akarsu; Ahmet Cem Dural; Burak Kankaya; Muhammet Ferhat Çelik; Osman Köneş; Meral Mert; Mustafa Uygar Kalaycı; Halil Alış Journal: Ulus Cerrahi Derg Date: 2014-03-01