{Reference Type}: Journal Article
{Title}: Volume-outcome relationship in adrenal surgery from 2009-2017 in Germany-a retrospective study.
{Author}: Uttinger KL;Reibetanz J;Diers J;Baum P;Pietryga S;Hendricks A;Schütze L;Baumann N;Wiegering V;Lock J;Dischinger U;Seyfried F;Fassnacht M;Germer CT;Wiegering A;
{Journal}: Eur J Endocrinol
{Volume}: 188
{Issue}: 1
{Year}: Jan 2023 10
{Factor}: 6.558
{DOI}: 10.1093/ejendo/lvac013
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>Descriptive, univariate, and multivariate analyses were applied to identify a possible volume-outcome relationship (complications, complication management, and mortality).<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.