Volume Matters: Longitudinal Retrospective Cohort Study of Outcomes Following Consolidation and Standardization of Adrenal Surgery

Rahbari, Reza; Alavi, Mubarika; Alvarez, Juan F.; Pérez, Carlos A.; Tedesco, Maureen M.; Brill, Elliot; Park, Judith J.; Svahn, Jonathan; Yutan, Elaine U.; Martinez, Arturo G.; Zhou, Minhao; Philipp, Scott R.; Herrinton, Lisa J.

doi:10.1245/s10434-021-10297-3

Ann Surg Oncol

2021

DOI: 10.1245/s10434-021-10297-3

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Volume Matters: Longitudinal Retrospective Cohort Study of Outcomes Following Consolidation and Standardization of Adrenal Surgery

Reza Rahbari

Mubarika Alavi

Juan F. Alvarez

et al.

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Cited by 3 publications

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“…7 Surgeon volume has been identified as a key factor for successful outcomes regardless of the surgeon specialty. 8 Surgical outcomes can also be influenced by social determinants of health (SDOH), considered a significant source of disparity that can threaten outcomes related to all kinds of major surgery. Based on the United States’ Healthy People 2030 initiative, they can be categorized into 5 domains: education, health care, environmental, social, and economic.…”

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Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health

Ditonno,

Franco,

Manfredi

et al. 2024

Urology Practice

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Study Need and Importance: There has been a notable increase in the incidence of adrenal masses over the past decade. Despite the widespread adoption of minimally invasive surgery (MIS), uncertainty persists regarding the optimal approach for adrenal carcinoma. Existing literature suggests that postoperative outcomes do not differ between urologists and general surgeons. Instead, surgical volume represents a critical factor for successful procedures. Additionally, contemporary practice underscores the significant impact of social determinants of health (SDOH) on determining treatment outcomes. Utilizing the PearlDiver Mariner database, a commercially available, nationwide database of insurance billing records, we performed a population-based analysis of trends and costs and outcomes of adrenalectomies in the United States. What We Found: In the present study we observed a decrease in the utilization of adrenalectomy over time, with a significant shift towards the adoption of MIS (Figure). Open surgery was associated with higher complications, longer hospital stays, and elevated costs. On the contrary, MIS was more cost-effective than open surgery and was the preferred approach, regardless of the physician's specialty. We reported comparable outcomes and costs when urologists were compared to general surgeons. At multivariate analysis, SDOH were significant predictors of 60-day postoperative complications. Limitations: The retrospective design of this study is related to inherent limitations. Moreover, this study relies on administrative data, potentially introducing coding-related biases. However, Current Procedural Terminology and International Classification of Disease codes are internationally standardized, mitigating this source of bias. Interpretation for Patient Care: The shift towards MIS aligns with its advantages in reducing complications, length of stay, and costs. The study underscores the impact of SDOH on surgical outcomes, emphasizing the need for further investigations into reducing health care disparities. These findings contribute valuable insights for clinicians, suggesting that MIS is the preferred approach for adrenalectomy, regardless of specialty, and highlighting the importance of addressing SDOH to improve patient outcomes.

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confidence: 99%

Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health

Ditonno,

Franco,

Manfredi

et al. 2024

Urology Practice

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European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Tsagarakis

Terzolo

et al. 2023

European Journal of Endocrinology

194

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Adrenal incidentalomas are adrenal masses detected on imaging performed for reasons other than suspected adrenal disease. In most cases, adrenal incidentalomas are non-functioning adrenocortical adenomas, but may also require therapeutic intervention including that for adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastases. Here, we provide a revision of the first international, interdisciplinary guidelines on incidentalomas. We followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system and updated systematic reviews on four predefined clinical questions crucial for the management of incidentalomas: A) How to assess risk of malignancy? ; B) How to define and manage mild autonomous cortisol secretion? ; C) Who should have surgical treatment and how should it be performed? ; D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected Recommendations: 1) Each adrenal mass requires dedicated adrenal imaging. Recent advances now allow discrimination between risk categories: Homogeneous lesions with HU ≤ 10 on unenhanced CT are benign and do not require any additional imaging independent of size. All other patients should be discussed in a multidisciplinary expert meeting, but only lesions >4 cm that are inhomogeneous or have HU >20 have sufficiently high risk of malignancy that surgery will be the usual management of choice. 2) Every patient needs a thorough clinical and endocrine work-up to exclude hormone excess including the measurement of plasma or urinary metanephrines and a 1-mg overnight dexamethasone suppression test (applying a cutoff value of serum cortisol ≤50 nmol/l (≤1.8 µg/dl)). Recent studies have provided evidence that most patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post dexamethasone >50 nmol/l (>1.8 µg/dl) harbor increased risk of morbidity and mortality. For this condition, we propose the term ‘mild autonomous cortisol secretion’ (MACS). 3) All patients with MACS should be screened for potential cortisol-related comorbidities that are potentially attributably to cortisol (e.g. hypertension and type 2 diabetes mellitus), to ensure these are appropriately treated. 4) In patients with MACS who also have relevant comorbidities surgical treatment should be considered in an individualized approach. 5) The appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. 6) Surgery is not usually indicated in patients with an asymptomatic, non-functioning unilateral adrenal mass and obvious benign features on imaging studies. Furthermore, we offer recommendations for the follow-up of non-operated patients, management of patients with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses, and for young and elderly patients with adrenal incidentalomas. Finally, we suggest ten important research questions for the future.

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ASO Author Reflections: Volume Matters—Longitudinal Retrospective Cohort Study of Outcomes Following Consolidation and Standardization of Adrenal Surgery

Rahbari

Herrinton

2021

Ann Surg Oncol

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Volume Matters: Longitudinal Retrospective Cohort Study of Outcomes Following Consolidation and Standardization of Adrenal Surgery

Cited by 3 publications

References 20 publications

Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health

Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health

European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors

ASO Author Reflections: Volume Matters—Longitudinal Retrospective Cohort Study of Outcomes Following Consolidation and Standardization of Adrenal Surgery

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