L. R. Kelz1, R. E. Roses1, D. L. Fraker1, H. Wachtel1 1Hospital Of The University Of Pennsylvania, Department Of Surgery, Philadelphia, PA, USA
Introduction:
Higher surgeon volume has a well-established relationship with surgical outcomes. Several definitions of a high-volume adrenal surgeon have been proposed, ranging from 4-7 adrenalectomies annually. The American Association of Endocrine Surgeons requires a minimum of 10 adrenalectomies for accreditation. The goal of this study was to analyze the relationship between annual adrenalectomy volume and perioperative outcomes.
Methods:
We performed a retrospective cohort study of patients undergoing adrenalectomy at a single institution (2013-2021). Data was abstracted from the electronic health record including demographics, operative cost, length of stay, operative duration, and readmissions. A high-volume surgeon was defined as performing >10 adrenalectomies annually. Group comparisons were performed based on surgeon volume using the Chi Square test or Wilcoxon Rank Sum test, as appropriate. A p-value of ≤0.05 was considered statistically significant.
Results:
Of 767 adrenalectomies, the mean patient age was 57.6 yrs (Standard Deviation: 13.3). 32 surgeons performed adrenalectomies; 15 surgeons performed only a single adrenalectomy in the study period. The majority (84.5%, n=648) of adrenalectomies were performed laparoscopically. The median procedure cost was $1650.71 (Interquartile Range (IQR): $1050.39). The median procedure duration was 109 min (IQR: 66 min). The median patient length of stay was 2 days (IQR: 3). 11.3% (n=87) of patients were readmitted within 30 days of surgery at a median of 23 days after surgery (IQR: 43). Patient insurance type was categorized into public or private; 143 patients had public insurance (18.6%) and 621 patients had private insurance (81%). 654 procedures (85%) were performed by high volume surgeons (n = 3), with a mean of 27 adrenalectomies annually. Compared to low-volume surgeons, high-volume surgeons had significantly higher rates of laparoscopic adrenalectomy (88% vs 62%, p<0.001), shorter median operative times (107 vs 134 min, p<0.001), shorter median length of stay (2 vs 3 days, p<0.001), and lower rates of readmission (15% vs 24%, p=0.026). Patients of high-volume surgeons were more likely to use private insurance (75% vs 66%, p=0.046). There was no statistically significant difference in operative costs by surgeon volume (high volume: $1639.12 vs low volume: $1831.04, p=0.12).
Conclusion:
High volume surgeons had higher rates of utilization of laparoscopic adrenalectomy and better perioperative outcomes including shorter operative times, shorter lengths of stay, and lower readmission rates compared to low volume surgeons. Surgeon volume should be considered to maximize patient outcomes and minimize costs related to operative time and length of stay.
