title: Results of adrenal surgery. Data of a Spanish National Survey.
abstract: OBJECTIVE
  Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments.
  
  
  METHODS
  Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05.
  
  
  RESULTS
  Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02).
  
  
  CONCLUSIONS
  In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.
authors.affiliation: Surgical Department, Virgen de Nieves Universitary Hospital, C/Hoya de Mora, 9, 2° A, 18008 Granada, Spain. jevillarmo@yahoo.es
authors.forename: Jesús María
authors.initials: JM
authors.lastname: Villar
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ortega
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bollo
authors.forename: César Pablo
authors.initials: CP
authors.lastname: Ramírez
authors.forename: Nuria
authors.initials: N
authors.lastname: Muñoz
authors.forename: Cristina
authors.initials: C
authors.lastname: Martínez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Domínguez-Adame
authors.forename: Juan
authors.initials: J
authors.lastname: Sancho
authors.forename: José Miguel
authors.initials: JM
authors.lastname: del Pino
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Couselo
authors.forename: Ana
authors.initials: A
authors.lastname: Carrión
authors.forename: Marifé
authors.initials: M
authors.lastname: Candel
authors.forename: Nieves
authors.initials: N
authors.lastname: Cáceres
authors.forename: José María
authors.initials: JM
authors.lastname: Octavio
authors.forename: Francisco
authors.initials: F
authors.lastname: Mateo
authors.forename: Lourdes
authors.initials: L
authors.lastname: Galán
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Ramia
authors.forename: Javier
authors.initials: J
authors.lastname: Aguiló
authors.forename: Francisco
authors.initials: F
authors.lastname: Herrera
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D018246:Adrenocortical Adenoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D013030:Spain; D011795:Surveys and Questionnaires