Javier Valero-Elizondo1, Yuhree Kim1, Jason D Prescott1, Georgios A Margonis1, Thuy B Tran2, Lauren M Postlewait3, Shishir K Maithel3, Tracy S Wang4, Jason A Glenn4, Ioannis Hatzaras5, Rivfka Shenoy5, John E Phay6, Kara Keplinger6, Ryan C Fields7, Linda X Jin7, Sharon M Weber8, Ahmed Salem8, Jason K Sicklick9, Shady Gad9, Adam C Yopp10, John C Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C Solorzano12, Colleen M Kiernan12, Konstantinos I Votanopoulos13, Edward A Levine13, George A Poultsides2, Timothy M Pawlik14,15. 1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. 3. Department of Surgery, Emory University, Atlanta, GA, USA. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Surgery, New York University School of Medicine, New York, NY, USA. 6. Department of Surgery, The Ohio State University, Columbus, OH, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 9. Department of Surgery, University of California San Diego, San Diego, CA, USA. 10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 11. Department of Surgery, University of California San Francisco, San Francisco, CA, USA. 12. Department of Surgery, Vanderbilt University, Nashville, TN, USA. 13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. 14. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu. 15. Division of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. METHODS: Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission. RESULTS: Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3-4 (n = 85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n = 38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75-13.61); P = 0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37-6.46); P = 0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16-6.51); P = 0.02), complication (OR, 1.91 (95 % CI, 1.20-3.05); P = 0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88-9.01); P < 0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44-11.17); P = 0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34-8.84); P = 0.01) remained independently associated with higher odds of readmission. CONCLUSION: Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively.
BACKGROUND:Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. METHODS: Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission. RESULTS: Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3-4 (n = 85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n = 38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75-13.61); P = 0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37-6.46); P = 0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16-6.51); P = 0.02), complication (OR, 1.91 (95 % CI, 1.20-3.05); P = 0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88-9.01); P < 0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44-11.17); P = 0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34-8.84); P = 0.01) remained independently associated with higher odds of readmission. CONCLUSION: Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively.
Entities:
Keywords:
Adrenocortical carcinoma; Readmission; Surgery
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