Adrenalectomy: Shouldn’t Urologists Be Doing More?
Adrenalectomy is an operation performed by both urologists and general surgeons, however the majority are performed by general surgeons. We wanted to investigate whether there was a difference in outcomes based on surgical specialty performing the procedure. If no differences exist, an argument can be made that urologists should be doing more adrenalectomies.
The National Surgical Quality Improvement Project (NSQIP) Participant Use File (PUF) was queried to extract all cases of adrenalectomies performed during the years 2011-2015. The following two CPT codes were used: 60540 (open) and 60650 (laparoscopic). The data were stratified by surgical specialty who performed the adrenalectomy (urology or general surgery). Our outcomes of interest included post-surgical complications, reoperations, 30-day readmission, mortality, and hospital length of stay.
A total of 3358 patients who underwent adrenalectomy were included, 3012 (90%) by a general surgeon and 334 (10%) by a urologist. Univariate analysis revealed no differences in post-surgical complication number, length of stay (LOS), rate of reoperation, 30-day readmission, and mortality between general surgeons and urologists performing adrenalectomies (p=0.76, p=0.29, p=0.37, p=0.98, and p=0.59) (Table 1). Separate regression models controlling for potential confounders confirmed that the differences in these outcomes between surgical specialties were not statistically significant. Surgeries performed by urologists had 13% greater odds of developing a complication, 55% lower odds of needing a reoperation, 2% fewer odds of 30-day readmission, and 35% fewer odds of death compared to surgeries performed under general surgeons, but these differences were not statistically significant (p=0.57, 0.29, 0.94, and 0.69). LOS was approximately 0.6 days shorter for the urologist cohort, but this was also not significant (p=0.17).
Surgical specialty did not make a difference in outcomes for patients undergoing adrenalectomy despite a large disparity in the number of procedures performed by urologists versus general surgeons. Given there was no difference in post-surgical complications, LOS, reoperation, readmission, and mortality, an argument can be made that urologists should be performing more adrenalectomies.