Authors: Melissa M Murphy Elan R Witkowski Sing Chau Ng Theodore P McDade Joshua S Hill Anne C Larkin Giles F Whalen Demetrius E Litwin Jennifer F Tseng
Publish Date: 2010/03/25
Volume: 24, Issue: 10, Pages: 2518-2526
Abstract
Adrenalectomy remains the definitive therapy for most adrenal neoplasms Introduced in the 1990s laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality This study aimed to evaluate national adrenalectomy trends including major postoperative complications and perioperative mortalityThe Nationwide Inpatient Sample was queried to identify all adrenalectomies performed during 1998–2006 Univariate and multivariate logistic regression were performed with adjustments for patient age sex comorbidities indication year of surgery laparoscopy hospital teaching status and hospital volume Annual incidence major inhospital postoperative complications and inhospital mortality were evaluatedUsing weighted national estimate 40363 patients with a mean age of 54 years were identified Men made up 40 of these patients and 77 of the patients were white The majority of adrenalectomies 83 were performed for benign disease The annual volume of adrenalectomies increased from 3241 in 1998 to 5323 in 2006 p 00001 trend analysis The overall inhospital mortality was 11 with no significant change Advanced age 45 years as the referent ≥65 years adjusted odds ratio AOR 410 95 confidence Interval CI 166–1010 and patient comorbidities Charlson score 0 as the referent Charlson score ≥2 AOR 433 96 CI 234–802 were independent predictors of inhospital mortality Indication year hospital teaching status and hospital volume did not independently affect perioperative mortality Major postoperative inhospital complications occurred in 72 of the cohort with a significant increasing trend 1998–2000 59 vs 2004–2006 81 p 00001 trend analysis Patient comorbidities Charlson score 0 as the referent Charlson score ≥2 AOR 477 95 CI 371–614 recent year of surgery 1998–2000 as the referent 2004–2006 AOR 140 95 CI 109–178 and benign disease malignant disease as the referent benign disease AOR 198 95 CI 155–253 were predictive of major postoperative complications at multivariable analyses whereas laparoscopy was protective no laparoscopy as the referent laparoscopy AOR 062 95 CI 047–082
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