S. Kim1, J. Hadaya1,2, Z. Tran1, K. Ali1, S. Bakhtiyar3, S. Sakowitz1, J. Wu4, P. Benharash2 1David Geffen School Of Medicine at UCLA, Cardiovascular Outcomes Research Laboratories, Los Angeles, CA, USA 2David Geffen School of Medicine at UCLA, Department Of Surgery, Los Angeles, CA, USA 3University of Colorado, Department Of Surgery, Aurora, CO, USA 4David Geffen School of Medicine at UCLA, Section Of Endocrine Surgery, Los Angeles, CA, USA
Introduction:
Adrenalectomy is commonly performed by both general surgeons and urologists. We evaluated differences in patient characteristics, conditions managed, surgical approach, and postoperative outcomes of adrenalectomy performed by general surgeons and urologists.
Methods:
All adults (≥ 18 years) undergoing adrenalectomy were identified using the 2012-2020 American College of Surgeons National Quality Improvement Program files. Diagnoses were categorized into non-functioning adenoma, adrenocortical carcinoma, adrenal metastases, cortisol-producing adenoma, aldosteronoma, or pheochromocytoma. Patients were divided into two groups by the specialty of the operating surgeon (urology or general surgery). The primary outcome of interest was rate of major complications (cardiac, renal, infectious, thrombotic, reintubation) following adrenalectomy. Secondary outcomes included mortality and unplanned readmission within 30-days after discharge. Multivariable logistic regression models were developed to evaluate the association of surgical specialty on outcomes of interest.
Results:
The study cohort included 8,286 patients who underwent adrenalectomy. Urologists performed 12.6% of adrenalectomies. Patients operated on by general surgeons were younger (27 [38-48] vs 31 years [41-50], P<0.001), more commonly female sex (59.7 vs 49.3%, P<0.001), and had similar ASA scores (American Society of Anesthesiologists) ≥3 class compared to patients treated by urologists. Urologists more commonly performed a great proportion of adrenalectomies for adrenocortical carcinoma (4.5 vs 2.8%, P<0.001), while general surgeons more often operated on patients with cortisol-producing adenomas (4.6 vs 0.8%, P<0.001) and pheochromocytoma (23.6 vs 17.5%, P<0.001). General surgeons more frequently used laparoscopy (86.1 vs 82.6%, P<0.001) relative to urologists.
Following risk adjustment, surgical specialty was not associated with major complications (Adjusted Odds Ratio [AOR] 0.9, 95% Confidence Interval (CI) 0.6-1.3, C-statistic= 0.78), mortality, operation time, postoperative infection, length of stay, or 30-day non-elective readmission (Figure). Notably, patient and operative factors such as laparoscopic approach (AOR 0.4, 95% CI 0.3-0.5), body mass index ≥35 (AOR 1.9, 95% CI 1.3-2.7), diagnosis of pheochromocytoma (AOR 1.2, 95% CI 1.1-1.5), and partially dependent functional status (AOR 5.9, 95% CI 3.1-11.2) were associated with increased odds of major complications.
Conclusion:
Outcomes following adrenalectomy are more strongly influenced by patient comorbidities, functional status, and operative approach, rather than surgeon specialty. These findings emphasize the ongoing safety of adrenalectomy by both general surgeons and urologists appropriately trained to perform this operation.
