title: Adverse Event Rates, Timing of Complications, and the Impact of Specialty on Outcomes Following Adrenal Surgery: An Analysis of 30-Day Outcome Data From the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
abstract: OBJECTIVE
  To report on 30-day adverse event rates and timing of complications following adrenal surgery; further, to investigate the impact of specialty (general surgery vs urology) on these outcomes using a large prospective multi-institutional data registry.
  
  
  METHODS
  Within the American College of Surgeons National Surgical Quality Improvement Program (2005-2012), patients undergoing adrenalectomy were identified (CPT-codes: 60540, 60545, 60650). Outcomes evaluated included complications, blood transfusion, length of stay, reintervention, readmission, and mortality. Complications were further evaluated in relation to discharge status (pre-/postdischarge). Multivariable regression models assessed association between specialty and 30-day morbidity/mortality.
  
  
  RESULTS
  During the study period, 4844 patients underwent adrenalectomy (95.7% general surgery). The overall complication rate was 7.5% (n = 363); 43.2% of the complications occurred postdischarge with a substantial proportion of major complications, including cardiac, pulmonary, renal, neurologic, septic, and deep venous thrombosis/pulmonary embolism also occurring postdischarge (29.9%). The overall blood transfusion, reintervention, readmission, and mortality rates were 3.9%, 2.0%, 6.4%, and 0.6%, respectively. In adjusted analyses, specialty did not have an effect on any of the outcomes (P  >  .05 all).
  
  
  CONCLUSIONS
  One in 13 patients suffers a complication postadrenalectomy. Approximately 40% of these complications occur postdischarge, primarily within the first 2 weeks of surgery. Accurate knowledge regarding 30-day adverse event rates and timing of complications that this study provides may facilitate improved patient-physician communication and encourage early patient follow-up in this critical window. Lastly, specialty does not seem to affect outcomes in American College of Surgeons National Surgical Quality Improvement Program participant hospitals.
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: asood1@hfhs.org.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: Kaustav
authors.initials: K
authors.lastname: Majumder
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kachroo
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Linda
authors.initials: L
authors.lastname: Hsu
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Department of Surgery, Henry Ford Health System, Detroit, MI.
authors.forename: Richard
authors.initials: R
authors.lastname: Kalu
authors.affiliation: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States