Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg, Germany.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany.
Front Endocrinol (Lausanne). 2022 Jul 27;13:914449. doi: 10.3389/fendo.2022.914449. eCollection 2022.
Adrenalectomies are rare procedures especially in childhood. So far, no large cohort study on this topic has been published with data on to age distribution, operative procedures, hospital volume and operative outcome.
This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes) of patients between the age 0 and 21 years in Germany were included.
A total of 523 patient records were identified. The mean age was 8.6 ± 7.7 years and 262 patients were female (50.1%). The majority of patients were between 0 and 5 years old (52% overall), while 11.1% were between 6 and 11 and 38.8% older than 12 years. The most common diagnoses were malignant neoplasms of the adrenal gland (56%, mostly neuroblastoma) with the majority being younger than 5 years. Benign neoplasms in the adrenal gland (D350) account for 29% of all cases with the majority of affected patients being 12 years or older. 15% were not defined regarding tumor behavior. Overall complication rate was 27% with a clear higher complication rate in resection for malignant neoplasia of the adrenal gland. Bleeding occurrence and transfusions are the main complications, followed by the necessary of relaparotomy. There was an uneven patient distribution between hospital tertiles (low volume, medium and high volume tertile). While 164 patients received surgery in 85 different "low volume" hospitals (0.2 cases per hospital per year), 205 patients received surgery in 8 different "high volume" hospitals (2.8 cases per hospital per year; p<0.001). Patients in high volume centers were significant younger, had more extended resections and more often malignant neoplasia. In multivariable analysis younger age, extended resections and open procedures were independent predictors for occurrence of postoperative complications.
Overall complication rate of adrenalectomies in the pediatric population in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a very uneven distribution of patient volume among hospitals.
肾上腺切除术是一种罕见的手术，特别是在儿童中。迄今为止，尚未有关于该主题的大型队列研究发表，其数据涉及年龄分布、手术过程、医院容量和手术结果。
这是一项对匿名全国医院计费数据（2009-2017 年的 DRG 数据）进行的回顾性分析。德国所有年龄在 0 至 21 岁之间接受过肾上腺手术（通过 OPS 代码定义）的患者都包含在内。
共确定了 523 例患者记录。平均年龄为 8.6±7.7 岁，262 例为女性（总体 50.1%）。大多数患者在 0 至 5 岁之间（总体 52%），11.1%在 6 至 11 岁之间，38.8%年龄大于 12 岁。最常见的诊断是肾上腺恶性肿瘤（56%，主要为神经母细胞瘤），其中大多数年龄小于 5 岁。肾上腺良性肿瘤（D350）占所有病例的 29%，大多数受影响的患者年龄在 12 岁或以上。15%的病例未明确肿瘤行为。总体并发症发生率为 27%，肾上腺恶性肿瘤切除术的并发症发生率明显更高。出血发生和输血是主要并发症，其次是需要再次剖腹手术。医院之间的患者分布不均（低容量、中容量和高容量 tertile）。164 例患者在 85 家不同的“低容量”医院接受手术（每家医院每年 0.2 例），205 例患者在 8 家不同的“高容量”医院接受手术（每家医院每年 2.8 例；p<0.001）。高容量中心的患者明显更年轻，接受了更广泛的切除术，并且更常患有恶性肿瘤。多变量分析显示，年龄较小、广泛切除和开放手术是术后并发症发生的独立预测因素。
德国儿科人群肾上腺切除术的总体并发症发生率较低，表明治疗质量良好。我们的分析显示，医院之间的患者容量分布非常不均。
