title: Surgeon volume impact on outcomes and cost of adrenal surgeries.
abstract: BACKGROUND
  The number of adrenal surgeries performed in the United Stated is continuing to increase. Identifying factors associated with favorable outcomes can have a major impact on cost-differences. We aim to assess the impact of surgeon volume on both clinical outcomes and cost following adrenal surgery.
  
  
  METHODS
  A cross-sectional analysis was performed utilizing data from the Nationwide Inpatient Sample, 2003-2009. Surgeon volumes included (adrenalectomies/year): low-volume (1), intermediate-volume (2-6), and high-volume (≥7).
  
  
  RESULTS
  A total of 7045 patients were included. Surgeries performed by low-volume surgeons were associated with a higher risk of postoperative complications [OR: 1.66, 95% CI: (1.23, 2.24)]. During the study period, if all operations performed by low-volume surgeons were selectively referred to intermediate-volume surgeons, a 7.7% cost savings would have been incurred. Potential savings were even higher (8.1%) if the operations had been performed by the high-volume surgeons. With the conservative assumption that there are 5000 adrenalectomies per year in the United States, the high-volume surgeons would produce savings of $8.8 million over a span of 14 years.
  
  
  CONCLUSIONS
  A surgeon's expertise is associated with favorable outcomes. Our model estimates that considerable cost savings are attainable with appropriate referrals to high volume endocrine surgeons.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
authors.forename: Z
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: A.B. Freeman School of Business, Tulane University, New Orleans, LA, United States.
authors.forename: R
authors.initials: R
authors.lastname: Robins
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States.
authors.forename: J
authors.initials: J
authors.lastname: Buell
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States. Electronic address: ekandil@tulane.edu.
authors.forename: E
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000315:Adrenalectomy / Q000191:economics*; D000328:Adult; D000368:Aged; D017046:Cost Savings; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D066231:Surgeons; D016896:Treatment Outcome
keywords: Adrenal cancer; Adrenal surgery; Cost analysis