Case Volume Is Not Associated With Outcomes After Adrenalectomy Performed by Urologic Surgeons

Area of Science:

• Urology
• Surgical Outcomes
• Adrenal Gland Surgery

Background:

• Surgeon volume is often considered a critical factor influencing surgical outcomes.
• The impact of surgeon experience, specifically adrenalectomy volume, on patient outcomes requires further investigation.
• Understanding the relationship between surgeon volume and adrenalectomy results is crucial for patient care and surgical training.

Purpose of the Study:

• To compare the surgical outcomes of adrenalectomy between low-volume and high-volume urologists.
• To evaluate the influence of surgeon experience on procedure length, blood loss, length of stay, and complication rates.
• To determine if extensive experience in renal surgery translates to better adrenalectomy outcomes.

Main Methods:

• Retrospective review of 304 adrenalectomies performed between 2009 and 2023 at a single center.
• Patients were stratified into low-volume (< 1-4 adrenalectomies/year) and high-volume (15 adrenalectomies/year) surgeon groups.
• Outcomes including procedure time, estimated blood loss, length of stay, and Clavien-Dindo complications were analyzed using multivariable regression.

Main Results:

• No significant differences were observed in procedure time, estimated blood loss, positive margin rates, or length of stay between high- and low-volume surgeons.
• The overall complication rate was significantly higher in the low-volume group (13.5%) compared to the high-volume group (5.3%) (P = .01).
• However, severe complications (Clavien 3 or higher) did not differ significantly between the groups (4% vs 1%, P = .22).

Conclusions:

• Surgical volume may not be a determining factor for adrenalectomy outcomes when performed by urologists with extensive retroperitoneal surgery experience.
• Outcomes appear comparable between high- and low-volume adrenalectomy surgeons in specialized, high-volume centers.
• Further research may explore the specific skills and experience in related retroperitoneal procedures that contribute to successful adrenalectomy outcomes regardless of adrenalectomy-specific volume.