Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma.
BACKGROUND
Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection.


METHODS
Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission.


RESULTS
Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3-4 (n = 85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n = 38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75-13.61); P = 0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37-6.46); P = 0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16-6.51); P = 0.02), complication (OR, 1.91 (95 % CI, 1.20-3.05); P = 0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88-9.01); P < 0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44-11.17); P = 0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34-8.84); P = 0.01) remained independently associated with higher odds of readmission.


CONCLUSIONS
Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Javier
J
Valero-Elizondo
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Yuhree
Y
Kim
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jason D
JD
Prescott
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Georgios A
GA
Margonis
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Thuy B
TB
Tran
Department of Surgery, Emory University, Atlanta, GA, USA.
Lauren M
LM
Postlewait
Department of Surgery, Emory University, Atlanta, GA, USA.
Shishir K
SK
Maithel
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Tracy S
TS
Wang
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Jason A
JA
Glenn
Department of Surgery, New York University School of Medicine, New York, NY, USA.
Ioannis
I
Hatzaras
Department of Surgery, New York University School of Medicine, New York, NY, USA.
Rivfka
R
Shenoy
Department of Surgery, The Ohio State University, Columbus, OH, USA.
John E
JE
Phay
Department of Surgery, The Ohio State University, Columbus, OH, USA.
Kara
K
Keplinger
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ryan C
RC
Fields
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Linda X
LX
Jin
Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sharon M
SM
Weber
Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed
A
Salem
Department of Surgery, University of California San Diego, San Diego, CA, USA.
Jason K
JK
Sicklick
Department of Surgery, University of California San Diego, San Diego, CA, USA.
Shady
S
Gad
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Adam C
AC
Yopp
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
John C
JC
Mansour
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Quan-Yang
QY
Duh
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Natalie
N
Seiser
Department of Surgery, Vanderbilt University, Nashville, TN, USA.
Carmen C
CC
Solorzano
Department of Surgery, Vanderbilt University, Nashville, TN, USA.
Colleen M
CM
Kiernan
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Konstantinos I
KI
Votanopoulos
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Edward A
EA
Levine
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
George A
GA
Poultsides
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu.|Division of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
Adrenocortical carcinoma; Readmission; Surgery