General Endocrine Surgery, Lille University Hospital CHU Lille, EGID - UMR 1190, Translational Research Laboratory for Diabetes, Lille University, Lille, France.
Lille University Hospital CHU Lille, EA 2694, Evaluation des technologies de santé et des pratiques médicales, Lille University, Lille, France.
Ann Surg. 2019 Nov;270(5):813-819. doi: 10.1097/SLA.0000000000003526.
To explore the determinants of postoperative outcomes of adrenal surgery in order to build a proposition for healthcare improvement.
Adrenalectomy is the recommended treatment for many benign and malignant adrenal diseases. Postoperative outcomes vary widely in the literature and their determinants remain ill-defined.
We based this retrospective cohort study on the "Programme de médicalisation des systèmes d'information" (PMSI), a national database that compiles discharge abstracts for every admission to French acute health care facilities. Diagnoses identified during the admission were coded according to the French adaptation of the 10th edition of the International Classification of Diseases (ICD-10). PMSI abstracts for all patients discharged between January 2012 and December 2017 were extracted. We built an Adrenalectomy-risk score (ARS) from logistic regression and calculated operative volume and ARS thresholds defining high-volume centers and high-risk patients with the CHAID method.
During the 6-year period of the study, 9820 patients (age: 55 ± 14; F/M = 1.1) were operated upon for adrenal disease. The global 90-day mortality rate was 1.5% (n = 147). In multivariate analysis, postoperative mortality was independently associated with age ≥75 years [odds ratio (OR): 5.3; P < 0.001], malignancy (OR: 2.5; P < 0.001), Charlson score ≥2 (OR: 3.6; P < 0.001), open procedure (OR: 3.2; P < 0.001), reoperation (OR: 4.5; P < 0.001), and low hospital caseload (OR: 1.8; P = 0.010). We determined that a caseload of 32 patients/year was the best threshold to define high-volume centers and 20 ARS points the best threshold to define high-risk patients.
High-risk patients should be referred to high-volume centers for adrenal surgery.
探讨肾上腺手术术后结局的决定因素，以期为改善医疗服务提出建议。
肾上腺切除术是许多良性和恶性肾上腺疾病的推荐治疗方法。文献中术后结局差异很大，其决定因素仍不明确。
我们基于“Programme de médicalisation des systèmes d'information”（PMSI）进行了这项回顾性队列研究，该数据库汇总了法国急性医疗机构每次住院的出院摘要。入院期间的诊断根据法国改编的第十版国际疾病分类（ICD-10）进行编码。提取了 2012 年 1 月至 2017 年 12 月期间所有出院患者的 PMSI 摘要。我们使用逻辑回归构建了肾上腺切除术风险评分（ARS），并使用 CHAID 方法计算了手术量和 ARS 阈值，以定义高容量中心和高危患者。
在研究的 6 年期间，9820 例（年龄：55±14；F/M=1.1）患者因肾上腺疾病接受了手术。全球 90 天死亡率为 1.5%（n=147）。多变量分析显示，术后死亡率与年龄≥75 岁[比值比（OR）：5.3；P<0.001]、恶性肿瘤（OR：2.5；P<0.001）、Charlson 评分≥2（OR：3.6；P<0.001）、开放手术（OR：3.2；P<0.001）、再次手术（OR：4.5；P<0.001）和医院低病例量（OR：1.8；P=0.010）独立相关。我们确定，每年 32 例患者的病例量是定义高容量中心的最佳阈值，20 分 ARS 是定义高危患者的最佳阈值。
高危患者应转诊至高容量中心进行肾上腺手术。
