Abstract：
OBJECTIVE: Adrenal resections are rare procedures of a heterogeneous nature. While recent European guidelines advocate a minimum annual caseload for adrenalectomies (6 per surgeon), evidence for a volume-outcome relationship for this surgery remains limited.
METHODS: A retrospective analysis of all adrenal resections in Germany between 2009 and 2017 using hospital billing data was performed. Hospitals were grouped into three tertiles of approximately equal patient volume.
METHODS: Descriptive, univariate, and multivariate analyses were applied to identify a possible volume-outcome relationship (complications, complication management, and mortality).
RESULTS: Around 17 040 primary adrenal resections were included. Benign adrenal tumors (n = 8,213, 48.2%) and adrenal metastases of extra-adrenal malignancies (n = 3582, 21.0%) were the most common diagnoses. Six hundred and thirty-two low-volume hospitals performed an equal number of resections as 23 high-volume hospitals (median surgeries/hospital/year 3 versus 31, P < .001). Complications were less frequent in high-volume hospitals (23.1% in low-volume hospitals versus 17.3% in high-volume hospitals, P < .001). The most common complication was bleeding in 2027 cases (11.9%) with a mortality of 4.6% (94 patients). Overall in-house mortality was 0.7% (n = 126). Age, malignancy, an accompanying resection, complications, and open surgery were associated with in-house mortality. In univariate analysis, surgery in high-volume hospitals was associated with lower mortality (OR: 0.47, P < .001). In a multivariate model, the tendency remained equal (OR: 0.59, P = .104). Regarding failure to rescue (death in case of complications), there was a trend toward lower mortality in high-volume hospitals.
CONCLUSIONS: The annual caseload of adrenal resections varies considerably among German hospitals. Our findings suggest that surgery in high-volume centers is advantageous for patient outcomes although fatal complications are rare.
METHODS: A retrospective analysis of all adrenal resections in Germany between 2009 and 2017 using hospital billing data was performed. Hospitals were grouped into three tertiles of approximately equal patient volume.
METHODS: Descriptive, univariate, and multivariate analyses were applied to identify a possible volume-outcome relationship (complications, complication management, and mortality).
RESULTS: Around 17 040 primary adrenal resections were included. Benign adrenal tumors (n = 8,213, 48.2%) and adrenal metastases of extra-adrenal malignancies (n = 3582, 21.0%) were the most common diagnoses. Six hundred and thirty-two low-volume hospitals performed an equal number of resections as 23 high-volume hospitals (median surgeries/hospital/year 3 versus 31, P < .001). Complications were less frequent in high-volume hospitals (23.1% in low-volume hospitals versus 17.3% in high-volume hospitals, P < .001). The most common complication was bleeding in 2027 cases (11.9%) with a mortality of 4.6% (94 patients). Overall in-house mortality was 0.7% (n = 126). Age, malignancy, an accompanying resection, complications, and open surgery were associated with in-house mortality. In univariate analysis, surgery in high-volume hospitals was associated with lower mortality (OR: 0.47, P < .001). In a multivariate model, the tendency remained equal (OR: 0.59, P = .104). Regarding failure to rescue (death in case of complications), there was a trend toward lower mortality in high-volume hospitals.
CONCLUSIONS: The annual caseload of adrenal resections varies considerably among German hospitals. Our findings suggest that surgery in high-volume centers is advantageous for patient outcomes although fatal complications are rare.
摘要：
目的：肾上腺切除术是罕见的异质性手术。尽管最近的欧洲指南提倡肾上腺切除术的最低年度病例数（每位外科医生6例），该手术的体积-结局关系的证据仍然有限.
方法：使用医院账单数据对2009年至2017年德国所有肾上腺切除术进行回顾性分析。医院被分为大约相等患者量的三个三分位数。
方法：描述性，单变量，并应用多变量分析来确定可能的容量-结果关系(并发症，并发症管理，和死亡率）。
结果：包括大约17040例原发性肾上腺切除术。最常见的诊断是良性肾上腺肿瘤（n=8,213，48.2％）和肾上腺外恶性肿瘤的肾上腺转移（n=3582，21.0％）。6132家小批量医院的切除数量与23家大批量医院的切除数量相同（中位手术/医院/3年与31年相比，P<.001）。在高容量医院中并发症较少（在低容量医院中为23.1％，在高容量医院中为17.3％，P<.001)。最常见的并发症是出血2027例（11.9%），死亡率为4.6%（94例）。总体内部死亡率为0.7%(n=126)。年龄,恶性肿瘤，伴随的切除，并发症,开放手术与内部死亡率相关.在单变量分析中，高容量医院的手术死亡率较低(OR:0.47,P<.001).在多变量模型中，趋势保持不变(OR：0.59，P=.104)。关于抢救失败（并发症死亡），在高容量医院中,死亡率有降低的趋势.
结论：德国医院每年肾上腺切除术的病例量差异很大。我们的发现表明，尽管致命的并发症很少见，但在高容量中心进行手术对患者预后有利。
方法：使用医院账单数据对2009年至2017年德国所有肾上腺切除术进行回顾性分析。医院被分为大约相等患者量的三个三分位数。
方法：描述性，单变量，并应用多变量分析来确定可能的容量-结果关系(并发症，并发症管理，和死亡率）。
结果：包括大约17040例原发性肾上腺切除术。最常见的诊断是良性肾上腺肿瘤（n=8,213，48.2％）和肾上腺外恶性肿瘤的肾上腺转移（n=3582，21.0％）。6132家小批量医院的切除数量与23家大批量医院的切除数量相同（中位手术/医院/3年与31年相比，P<.001）。在高容量医院中并发症较少（在低容量医院中为23.1％，在高容量医院中为17.3％，P<.001)。最常见的并发症是出血2027例（11.9%），死亡率为4.6%（94例）。总体内部死亡率为0.7%(n=126)。年龄,恶性肿瘤，伴随的切除，并发症,开放手术与内部死亡率相关.在单变量分析中，高容量医院的手术死亡率较低(OR:0.47,P<.001).在多变量模型中，趋势保持不变(OR：0.59，P=.104)。关于抢救失败（并发症死亡），在高容量医院中,死亡率有降低的趋势.
结论：德国医院每年肾上腺切除术的病例量差异很大。我们的发现表明，尽管致命的并发症很少见，但在高容量中心进行手术对患者预后有利。
