Gallagher Scott F, Wahi Monika, Haines Krista L, Baksh Kathryn, Enriquez Jonathan, Lee Tien-Min, Murr Michel M, Fabri P Jeff
Department of Surgery, USF Health, University of South Florida College of Medicine, Tampa, Florida 33606, USA.
Surgery. 2007 Dec;142(6):1011-21; discussion 1011-21. doi: 10.1016/j.surg.2007.09.024.
Adrenalectomy rates seem to be increasing in Florida, possibly due to increased availability of laparoscopic adrenalectomy, identification of incidentalomas, and access to care for minorities. We hypothesized that the rate of adrenalectomies in Florida increased from 1998-2005 while characteristics of patients, diagnoses, operations, and operating physicians changed over this period.
Prospectively-collected, mandatory-reported, hospital discharge data for all inpatient adrenalectomies undertaken in Florida from 1998-2005 were obtained along with Florida census and physician certification and education data. Characteristics of adrenalectomy patients, diagnoses, operations, and physicians were analyzed.
1816 adrenalectomies were available for analysis. Yearly rates of adrenalectomy nearly doubled from 1.20 to 2.26 per 100,000 Florida residents (P = .0024). Overall, patient characteristics such as demographics, indications and comorbidities did not change, whereas hospital charges increased and length-of-stay (LOS) significantly decreased (P = .0031 and P < .0001, respectively). There was a non-significant trend toward a yearly increase in physician volume and an inverse relationship between physician volume categories and mean LOS (P < .0001).
The rate of adrenalectomies is increasing in Florida. This increase was not associated with distinct trends in patient characteristics, although a significant decrease in LOS was identified. As these trends continue and adrenalectomy is applied more liberally, indications for adrenalectomy may need to be re-evaluated.
在佛罗里达州，肾上腺切除术的比率似乎在上升，这可能是由于腹腔镜肾上腺切除术的可及性增加、偶发瘤的发现以及少数族裔获得医疗服务的机会增多。我们推测，1998年至2005年期间，佛罗里达州肾上腺切除术的比率有所上升，而在此期间患者的特征、诊断、手术以及手术医生发生了变化。
获取了1998年至2005年在佛罗里达州进行的所有住院肾上腺切除术的前瞻性收集、强制报告的医院出院数据，以及佛罗里达州的人口普查数据和医生认证及教育数据。对肾上腺切除术患者的特征、诊断、手术和医生进行了分析。
有1816例肾上腺切除术可供分析。每10万名佛罗里达州居民的肾上腺切除术年比率从1.20几乎翻倍至2.26（P = 0.0024）。总体而言，患者特征如人口统计学、适应症和合并症没有变化，而医院费用增加，住院时间（LOS）显著缩短（分别为P = 0.0031和P < 0.0001）。医生手术量有逐年增加的非显著趋势，且医生手术量类别与平均住院时间之间呈负相关（P < 0.0001）。
佛罗里达州肾上腺切除术的比率在上升。尽管发现住院时间显著缩短，但这种上升与患者特征的明显趋势无关。随着这些趋势的持续以及肾上腺切除术的应用更加广泛，可能需要重新评估肾上腺切除术的适应症。
