ORLANDO, FL USA (UroToday.com) - At this podium session, Dr. Adam Callaway presented a study looking at national trends in adrenalectomy with regards to surgeon and surgical approach type, and factors impacting surgical approach. The study utilized the Nationwide Inpatient Sample (NIS) database and included patients undergoing adrenalectomy between 2002-2011 without concomitant nephrectomy and its purpose was to address two important questions: who is performing adrenalectomies nationally (urologists vs general surgeons) and how are adrenalectomies being performed (open vs minimally invasively) and why?
Overall, nearly 60 000 adrenalectomies were included in the study. Over time, the study found that there was a decline in the proportion of cases performed by urologists from approximately 75% in 2003 to 60% in 2009. Minimally invasive adrenalectomy was performed 20% of the time, and this increased approximately 4% annually over the course of the study but lagged significantly behind the use of minimally invasive technologies for radical prostatectomy and partial nephrectomy. More recently, from 2009 to 2011, however, the use of minimally invasive surgery increased 12% annually. Open surgery was found in this study to result in an increased number of postoperative complications, a longer hospital stay, and increased total costs.
The panel and audience members discussed concerns regarding the unexpectedly low proportion of adrenalectomies found to be performed minimally invasively by this study which Dr. Callaway discussed may be a product of undercoding of laparoscopic procedures within the database. In an interesting discussion about ways in which to reverse the trend of increased general surgery referral for adrenalectomy, Dr. Callaway and some audience members discussed the importance of creating good relationships with referring doctors, including endocrinologists and internists. The potential advantage of increased familiarity with robotic surgery when compared to general surgeons could also be promoted to increase referrals, particularly of more difficult cases or in cases where partial adrenalectomy is desirable or necessary.
Click HERE to listen to an interview with Adam Callaway, MD, the presenter of this study
Presented by Adam C. Callaway at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Written by Timothy Ito, MD, medical writer for UroToday.com