Trends in adrenalectomy rates, indications, and physician volume: A statewide analysis of 1816 adrenalectomies.
BACKGROUND
Adrenalectomy rates seem to be increasing in Florida, possibly due to increased availability of laparoscopic adrenalectomy, identification of incidentalomas, and access to care for minorities. We hypothesized that the rate of adrenalectomies in Florida increased from 1998-2005 while characteristics of patients, diagnoses, operations, and operating physicians changed over this period.


METHODS
Prospectively-collected, mandatory-reported, hospital discharge data for all inpatient adrenalectomies undertaken in Florida from 1998-2005 were obtained along with Florida census and physician certification and education data. Characteristics of adrenalectomy patients, diagnoses, operations, and physicians were analyzed.


RESULTS
1816 adrenalectomies were available for analysis. Yearly rates of adrenalectomy nearly doubled from 1.20 to 2.26 per 100,000 Florida residents (P = .0024). Overall, patient characteristics such as demographics, indications and comorbidities did not change, whereas hospital charges increased and length-of-stay (LOS) significantly decreased (P = .0031 and P < .0001, respectively). There was a non-significant trend toward a yearly increase in physician volume and an inverse relationship between physician volume categories and mean LOS (P < .0001).


CONCLUSIONS
The rate of adrenalectomies is increasing in Florida. This increase was not associated with distinct trends in patient characteristics, although a significant decrease in LOS was identified. As these trends continue and adrenalectomy is applied more liberally, indications for adrenalectomy may need to be re-evaluated.
Department of Surgery, USF Health, University of South Florida College of Medicine, Tampa, Florida 33606, USA. sgallagh@health.usf.edu
Scott F
SF
Gallagher
Monika
M
Wahi
Krista L
KL
Haines
Kathryn
K
Baksh
Jonathan
J
Enriquez
Tien-Min
TM
Lee
Michel M
MM
Murr
P Jeff
PJ
Fabri
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000453:epidemiology / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D000315:Adrenalectomy / Q000706:statistics & numerical data / Q000639:trends*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013043:Specialties, Surgical / Q000706:statistics & numerical data; D016526:Workload