title: Adrenal surgery in England: better outcomes in high-volume practices.
abstract: Adrenal surgery is performed by a variety of surgical specialities in differing environments and volumes. International data suggest that there is a correlation between adrenal surgery volume and outcomes but there are no UK data to support this or UK surgical guidelines. A multidisciplinary team representing the stakeholders in adrenal disease is preparing a national guidance on adrenal surgery. A review of the outcomes for adrenal surgery in England was performed to correlate outcomes with the volume of surgeon practice.
  
  
  
  Hospital Episode Statistics (HES) data for the National Health Service (NHS) in England in the tax year 2013-2014 were examined for adrenal surgery. Length of hospital stay and rate of postoperative readmission were assessed as surrogate quality markers and a comparison made between 'high-' and 'low-' volume surgeons.
  
  
  
  A total of 795 adult adrenalectomies were performed by 222 different surgeons with a range of between 1 and 34 adrenalectomies performed per surgeon. Only thirty-six (16%) adrenal surgeons performed 6 or more adrenalectomies. A total of 186 surgeons (84%) performed a median of one adrenalectomy a year. Length of stay and readmission rate within thirty days of operation was 60% longer and 47% higher, respectively, when performed by low-volume surgeons.
  
  
  
  The current provision of adrenal surgery in the UK is not in the best interests of patients and is not cost-effective for the NHS. Adrenal surgery is best performed by higher volume surgeons in centres with dedicated adrenal multidisciplinary teams expert in all aspects of care of the adrenal patient.
authors.affiliation: Endocrine Surgery, Hammersmith Hospital, London, UK.
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
authors.affiliation: Urology, Plymouth Hospitals NHS Trust, Plymouth, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dickinson
authors.affiliation: Anaesthesia, St Georges Hospital, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips
authors.affiliation: Radiology, St Bartholomew's Hospital, London, UK.
authors.forename: Anju
authors.initials: A
authors.lastname: Sahdev
authors.affiliation: Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Bliss
authors.affiliation: Surgery, University of Wales, Cardiff, UK.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Rasheed
authors.affiliation: Surgery, Aberdeen Hospital, Aberdeen, UK.
authors.forename: Zygmunt
authors.initials: Z
authors.lastname: Krukowski
authors.affiliation: Academic Unit of Diabetes, Endocrinology & Metabolism, University of Sheffield, Sheffield, UK.
authors.forename: John
authors.initials: J
authors.lastname: Newell-Price
mesh_terms: D000293:Adolescent; D000315:Adrenalectomy / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004739:England; D061847:Hospitals, High-Volume / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D016239:MEDLINE; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D066231:Surgeons; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult