Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Surgery. 2022 Jun;171(6):1519-1525. doi: 10.1016/j.surg.2021.10.065. Epub 2021 Nov 29.
The incidence of adrenal incidentaloma has been increasing, and indications of and approaches to adrenalectomy are diverse. Drivers of complications and costs are not well identified.
The 2016 National Inpatient Sample data were used to identify patients who underwent adrenalectomy for benign adrenal disorders, such as Cushing syndrome, primary hyperaldosteronism, pheochromocytoma, and other benign neoplasms defined using the 10th Revision of the International Classification of Diseases. The primary outcome was determining the factors associated with clinical outcomes, perioperative complications, and hospitalization costs.
Using weighted estimates of the national sample data, 5,140 patients were identified. The mean age was 55 years. The majority of adrenalectomies were performed laparoscopically (48.5%) followed by a robotic approach (32.7%). The postoperative complication rate was 7.6%. In adjusted multivariable analyses, independent risk factors for perioperative complications included Hispanic race (odds ratio, 2.5; P = .01), and perioperative comorbid heart failure (odds ratio, 6.3; P < .001) and respiratory failure (odds ratio, 9.9; P < .001). The mean cost was $18,122. Independent risk factors associated with decrease of cost were female sex and primary hyperaldosteronism; factors associated with increased cost were pheochromocytoma, intraoperative complications, perioperative underlying comorbid respiratory failure and heart failure, and postoperative complications (P < .001).
Among patients undergoing adrenalectomy for benign adrenal disorders, underlying comorbidities, including heart and respiratory failure, should be considered when recommending adrenalectomy, as these may increase the postoperative complication rates and hospitalization costs.
肾上腺意外瘤的发病率不断增加，肾上腺切除术的适应证和方法也多种多样。并发症和成本的驱动因素尚未得到很好的确定。
使用 2016 年国家住院患者样本数据，确定因库欣综合征、原发性醛固酮增多症、嗜铬细胞瘤和其他良性肿瘤等良性肾上腺疾病接受肾上腺切除术的患者，这些疾病使用国际疾病分类第 10 次修订版进行定义。主要结果是确定与临床结果、围手术期并发症和住院费用相关的因素。
使用全国样本数据的加权估计值，确定了 5140 名患者。平均年龄为 55 岁。大多数肾上腺切除术是通过腹腔镜（48.5%）进行的，其次是机器人手术（32.7%）。术后并发症发生率为 7.6%。在调整后的多变量分析中，围手术期并发症的独立危险因素包括西班牙裔（优势比，2.5；P=0.01）以及围手术期合并心力衰竭（优势比，6.3；P<0.001）和呼吸衰竭（优势比，9.9；P<0.001）。平均费用为 18122 美元。与成本降低相关的独立危险因素是女性和原发性醛固酮增多症；与成本增加相关的因素是嗜铬细胞瘤、术中并发症、围手术期潜在的合并呼吸衰竭和心力衰竭以及术后并发症（P<0.001）。
在因良性肾上腺疾病接受肾上腺切除术的患者中，推荐进行肾上腺切除术时应考虑潜在的合并症，包括心脏和呼吸衰竭，因为这些因素可能会增加术后并发症发生率和住院费用。
