Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA 01655, USA.
Surg Endosc. 2010 Oct;24(10):2518-26. doi: 10.1007/s00464-010-0996-z. Epub 2010 Mar 25.
Adrenalectomy remains the definitive therapy for most adrenal neoplasms. Introduced in the 1990s, laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality. This study aimed to evaluate national adrenalectomy trends, including major postoperative complications and perioperative mortality.
The Nationwide Inpatient Sample was queried to identify all adrenalectomies performed during 1998-2006. Univariate and multivariate logistic regression were performed, with adjustments for patient age, sex, comorbidities, indication, year of surgery, laparoscopy, hospital teaching status, and hospital volume. Annual incidence, major in-hospital postoperative complications, and in-hospital mortality were evaluated.
Using weighted national estimate, 40,363 patients with a mean age of 54 years were identified. Men made up 40% of these patients, and 77% of the patients were white. The majority of adrenalectomies (83%) were performed for benign disease. The annual volume of adrenalectomies increased from 3,241 in 1998 to 5,323 in 2006 (p < 0.0001, trend analysis). The overall in-hospital mortality was 1.1%, with no significant change. Advanced age (< 45 years as the referent; ≥ 65 years: adjusted odds ratio [AOR], 4.10; 95%; confidence Interval [CI], 1.66-10.10) and patient comorbidities (Charlson score 0 as the referent; Charlson score ≥ 2: AOR, 4.33; 96% CI, 2.34-8.02) were independent predictors of in-hospital mortality. Indication, year, hospital teaching status, and hospital volume did not independently affect perioperative mortality. Major postoperative in-hospital complications occurred in 7.2% of the cohort, with a significant increasing trend (1998-2000 [5.9%] vs 2004-2006 [8.1%]; p < 0.0001, trend analysis). Patient comorbidities (Charlson score 0 as the referent; Charlson score ≥ 2: AOR, 4.77; 95% CI, 3.71-6.14), recent year of surgery (1998-2000 as the referent; 2004-2006: AOR, 1.40; 95% CI, 1.09-1.78), and benign disease (malignant disease as the referent; benign disease: AOR, 1.98; 95% CI, 1.55-2.53) were predictive of major postoperative complications at multivariable analyses, whereas laparoscopy was protective (no laparoscopy as the referent; laparoscopy: AOR, 0.62; 95% CI, 0.47-0.82).
Adrenalectomy is increasingly performed nationwide for both benign and malignant indications. In this study, whereas perioperative mortality remained low, major postoperative complications increased significantly.
大多数肾上腺肿瘤仍采用肾上腺切除术作为明确的治疗方法。腹腔镜肾上腺切除术于 20 世纪 90 年代引入，据报道其相关发病率和死亡率较低。本研究旨在评估全国性肾上腺切除术趋势，包括主要术后并发症和围手术期死亡率。
通过全美住院患者样本调查 1998 年至 2006 年期间进行的所有肾上腺切除术。采用单变量和多变量逻辑回归分析，调整患者年龄、性别、合并症、适应证、手术年份、腹腔镜检查、医院教学地位和医院容量等因素。评估了年度发病率、主要院内术后并发症和院内死亡率。
使用加权全国估计值，确定了 40363 名平均年龄为 54 岁的患者。这些患者中有 40%为男性，77%为白人。大多数肾上腺切除术（83%）是为良性疾病而进行的。肾上腺切除术的年手术量从 1998 年的 3241 例增加到 2006 年的 5323 例（p < 0.0001，趋势分析）。整体院内死亡率为 1.1%，无明显变化。高龄（< 45 岁为参照；≥ 65 岁：调整后的优势比 [OR]，4.10；95%置信区间 [CI]，1.66-10.10）和患者合并症（Charlson 评分 0 为参照；Charlson 评分≥2：OR，4.33；96%CI，2.34-8.02）是院内死亡率的独立预测因素。适应证、年份、医院教学地位和医院容量并未独立影响围手术期死亡率。该队列中发生了 7.2%的主要院内术后并发症，且呈显著上升趋势（1998-2000 年为 5.9%，2004-2006 年为 8.1%；p < 0.0001，趋势分析）。患者合并症（Charlson 评分 0 为参照；Charlson 评分≥2：OR，4.77；95%CI，3.71-6.14）、最近手术年份（1998-2000 年为参照；2004-2006 年：OR，1.40；95%CI，1.09-1.78）和良性疾病（恶性疾病为参照；良性疾病：OR，1.98；95%CI，1.55-2.53）是多变量分析中主要术后并发症的预测因素，而腹腔镜检查具有保护作用（无腹腔镜检查为参照；腹腔镜检查：OR，0.62；95%CI，0.47-0.82）。
全国范围内，腹腔镜肾上腺切除术越来越多地用于治疗良性和恶性疾病。在本研究中，尽管围手术期死亡率仍然较低，但主要术后并发症显著增加。
