根据外科医生手术量的不同，肾上腺切除术的入路和结果。
Adrenalectomy approach and outcomes according to surgeon volume.
机构信息
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Am J Surg. 2024 Mar;229:44-49. doi: 10.1016/j.amjsurg.2023.10.042. Epub 2023 Oct 23.
BACKGROUND
This study assessed the relationship between surgeon volume, operative management, and resource utilization in adrenalectomy.
METHODS
Isolated adrenalectomies performed within our health system were identified (2016-2021). High-volume surgeons were defined as those performing ≥6 cases/year. Outcomes included indication for surgery, perioperative outcomes, and costs.
RESULTS
Of 476 adrenalectomies, high-volume surgeons (n = 3) performed 394, while low-volume surgeons (n = 12) performed 82. High-volume surgeons more frequently operated for pheochromocytoma (19% vs. 16%, p < 0.001) and less frequently for metastasis (6.4% vs. 23%, p < 0.001), more frequently used laparoscopy (95% vs. 80%, p < 0.001), and had lower operative supply costs ($1387 vs. $1,636, p = 0.037). Additionally, laparoscopic adrenalectomy was associated with shorter length of stay (-3.43 days, p < 0.001), lower hospitalization costs (-$72,417, p < 0.001), and increased likelihood of discharge to home (OR 17.03, p = 0.008).
CONCLUSIONS
High-volume surgeons more often resect primary adrenal pathology and utilize laparoscopy. Laparoscopic adrenalectomy is, in turn, associated with decreased healthcare resource utilization.
背景
本研究评估了外科医生手术量、手术管理和肾上腺切除术资源利用之间的关系。
方法
在我们的医疗体系内确定了孤立性肾上腺切除术（2016-2021 年）。高容量外科医生的定义是每年进行≥6 例手术的医生。结果包括手术指征、围手术期结果和成本。
结果
在 476 例肾上腺切除术患者中，高容量外科医生（n=3）完成了 394 例，低容量外科医生（n=12）完成了 82 例。高容量外科医生更常因嗜铬细胞瘤（19% vs. 16%，p<0.001）而行手术，而较少因转移（6.4% vs. 23%，p<0.001）而行手术，更常使用腹腔镜（95% vs. 80%，p<0.001），且手术供应成本较低（$1387 比$1636，p=0.037）。此外，腹腔镜肾上腺切除术与较短的住院时间（-3.43 天，p<0.001）、较低的住院费用（-$72,417，p<0.001）和增加的家庭出院可能性（OR 17.03，p=0.008）相关。
结论
高容量外科医生更常切除原发性肾上腺病变并使用腹腔镜。腹腔镜肾上腺切除术继而与减少医疗保健资源利用相关。
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