Faiena Izak, Tabakin Alexandra, Leow Jeffrey, Patel Neal, Modi Parth K, Salmasi Amirali H, Chung Benjamin I, Chang Steven L, Singer Eric A
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Can J Urol. 2017 Oct;24(5):8990-8997.
Data on the utilization of open, laparoscopic and robotic adrenalectomy on a national level is limited.
Data on patients who underwent open, laparoscopic, or robotic adrenalectomy for benign or malignant disease in the US from 2003-2013 were extracted using ICD-9 codes from the Premier Hospital Database. Surgeon specialty, patient demographics, hospital characteristics, and complications were compared. Data were analyzed using univariate and multivariable logistic regression analyses.
A total of 8,831 adrenalectomies were performed for benign and malignant tumors. There was no significant difference in rate of adrenalectomy with regards to comorbidities, insurance status, or hospital characteristics. Non-urologists performed adrenalectomy more often for both benign (57% versus 43%; p = 0.011) and malignant disease (66% versus 34%; p = 0.011). Across all indications, non-urologists performed open surgery most often followed by laparoscopic and robotic approaches (56.3% versus 37.4% versus 6.4%, respectively), compared to urologists (48.8% versus 38.4% versus 12.9%, respectively). Overall, urologists were more likely to use laparoscopic or robotic approaches (p = 0.001). There was no difference in complication rates or operative times between surgical specialties or by surgeon/hospital case volume. On multivariable regression analysis, the best predictor of major complication was a Charlson Comorbidity Index (CCI) ≥ 2 (OR 3.9, 95%CI 2.1-7.1; p = < 0.001). Compared to open surgery, laparoscopy had significantly reduced odds of major complication (OR 0.6, 95%CI 0.3-0.9; p = 0.03). Patients undergoing robotic procedures had the shortest length of stay.
In this retrospective study, adrenalectomy was more commonly performed by non-urologists via an open approach. Patients with CCI ≥ 2 were more likely to have postoperative complications while surgeon volume, hospital volume, and surgical approach did not influence complication rates.
关于全国范围内开放性、腹腔镜及机器人辅助肾上腺切除术的使用数据有限。
利用2003年至2013年美国Premier医院数据库中的ICD - 9编码，提取接受开放性、腹腔镜或机器人辅助肾上腺切除术治疗良性或恶性疾病患者的数据。比较外科医生专业、患者人口统计学特征、医院特征及并发症情况。采用单因素和多因素逻辑回归分析对数据进行分析。
共进行了8831例肾上腺切除术治疗良性和恶性肿瘤。在合并症、保险状况或医院特征方面，肾上腺切除术的发生率无显著差异。非泌尿外科医生进行肾上腺切除术治疗良性疾病（57%对43%；p = 0.011）和恶性疾病（66%对34%；p = 0.011）的频率更高。在所有适应证中，与泌尿外科医生相比（分别为48.8%对38.4%对12.9%），非泌尿外科医生最常采用开放性手术，其次是腹腔镜和机器人辅助手术（分别为56.3%对37.4%对6.4%）。总体而言，泌尿外科医生更倾向于使用腹腔镜或机器人辅助手术（p = 0.001）。手术专科之间或外科医生/医院病例量之间的并发症发生率和手术时间无差异。多因素回归分析显示，主要并发症的最佳预测指标是Charlson合并症指数（CCI）≥2（OR 3.9，95%CI 2.1 - 7.1；p = < 0.001）。与开放性手术相比，腹腔镜手术发生主要并发症的几率显著降低（OR 0.6，95%CI 0.3 - 0.9；p = 0.03）。接受机器人辅助手术的患者住院时间最短。
在这项回顾性研究中，肾上腺切除术更常由非泌尿外科医生通过开放性手术进行。CCI≥2的患者术后更易发生并发症，而外科医生手术量、医院手术量和手术方式并未影响并发症发生率。
