Hauch Adam, Al-Qurayshi Zaid, Kandil Emad
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA,
Ann Surg Oncol. 2015 Jan;22(1):103-10. doi: 10.1245/s10434-014-3750-2. Epub 2014 May 3.
Surgeon experience has been demonstrated to result in better outcomes after a variety of advanced operations. Less information is available regarding adrenal surgery. We compared the outcomes after adrenalectomy for a variety of indications and determined the effect of surgeon's case volume.
Cross-sectional analysis was performed using ICD-9 procedure codes included in the Nationwide Inpatient Sample from 2003 to 2009 to identify all adult patients who underwent unilateral or bilateral adrenalectomy for benign or malignant conditions. Logistic regression was used to test for interaction between surgeon case volume (low = 1, intermediate = 2-5, and high = >5 adrenalectomies per year), diagnosis, type of operation performed, and risk of complications.
A total of 7,829 adrenalectomies were included. Risk of complications after bilateral adrenalectomy was 23.4 % compared to 15.0 % for unilateral adrenalectomy (odds ratio 2.165, 95 % confidence interval 1.335, 3.512). Malignancy was associated with higher risk of complication (23.1 %) than benign disease (13.2 %) (odds ratio 1.685, 95 % confidence interval 1.371, 2.072). Complication rates for low- and intermediate-volume surgeons were 18.8 and 14.6 %, respectively, and both were significantly higher than complications by high-volume surgeons (11.6 %, p < 0.05). Length of stay and charges were both significantly less for high-volume surgeons compared to lower-volume groups (p < 0.05).
Low surgeon case volumes and adrenal surgery for malignant or bilateral disease are associated with increased risk of postoperative complications. Length of stay and charges were significantly less when high-volume surgeons perform adrenal surgery.
已有证据表明，外科医生的经验会使各种高难度手术后的治疗效果更佳。然而，关于肾上腺手术的相关信息较少。我们比较了因各种适应证行肾上腺切除术后的治疗效果，并确定了外科医生手术量的影响。
采用2003年至2009年全国住院患者样本中的ICD - 9手术编码进行横断面分析，以确定所有因良性或恶性疾病接受单侧或双侧肾上腺切除术的成年患者。采用逻辑回归分析检验外科医生手术量（低 = 每年1例，中等 = 每年2 - 5例，高 = 每年>5例肾上腺切除术）、诊断、所施行手术类型与并发症风险之间的相互作用。
共纳入7829例肾上腺切除术。双侧肾上腺切除术后的并发症风险为23.4%，而单侧肾上腺切除术为15.0%（优势比2.165，95%置信区间1.335，3.512）。恶性疾病的并发症风险（23.1%）高于良性疾病（13.2%）（优势比1.685，95%置信区间1.371，2.072）。低手术量和中等手术量外科医生的并发症发生率分别为18.8%和14.6%，两者均显著高于高手术量外科医生（11.6%，p < 0.05）。与低手术量组相比，高手术量外科医生的住院时间和费用均显著更低（p < 0.05）。
外科医生手术量低以及因恶性或双侧疾病行肾上腺手术与术后并发症风险增加相关。高手术量外科医生进行肾上腺手术时，住院时间和费用显著更低。
