Background: Adrenalectomies are rare procedures especially in childhood. So
far, no large cohort study on this topic has been published with data on to age
distribution, operative procedures, hospital volume and operative outcome.
Methods: This is a retrospective analysis of anonymized nationwide hospital
billing data (DRG data, 2009-2017). All adrenal surgeries (defined by OPS codes)
of patients between the age 0 and 21 years in Germany were included.
Results: A total of 523 patient records were identified. The mean age was 8.6 ±
7.7 years and 262 patients were female (50.1%). The majority of patients were
between 0 and 5 years old (52% overall), while 11.1% were between 6 and 11 and
38.8% older than 12 years. The most common diagnoses were malignant
neoplasms of the adrenal gland (56%, mostly neuroblastoma) with the
majority being younger than 5 years. Benign neoplasms in the adrenal gland
(D350) account for 29% of all cases with the majority of affected patients being
12 years or older. 15% were not defined regarding tumor behavior. Overall
complication rate was 27% with a clear higher complication rate in resection for
malignant neoplasia of the adrenal gland. Bleeding occurrence and
transfusions are the main complications, followed by the necessary of
relaparotomy. There was an uneven patient distribution between hospital
tertiles (low volume, medium and high volume tertile). While 164 patients
received surgery in 85 different “low volume” hospitals (0.2 cases per hospital
per year), 205 patients received surgery in 8 different “high volume” hospitals
(2.8 cases per hospital per year; p<0.001). Patients in high volume centers were
significant younger, had more extended resections and more often malignant
neoplasia. In multivariable analysis younger age, extended resections and open
procedures were independent predictors for occurrence of postoperative
complications.
Conclusion: Overall complication rate of adrenalectomies in the pediatric population
in Germany is low, demonstrating good therapeutic quality. Our analysis revealed a
very uneven distribution of patient volume among hospitals.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:87977 |
| Date | 13 November 2023 |
| Creators | Uttinger, Konstantin L., Riedmeier, Maria, Reibetanz, Joachim, Meyer, Thomas, Germer, Christoph Thomas, Fassnacht, Martin, Wiegering, Armin, Wiegering, Verena |
| Publisher | Frontiers Media S.A. |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 10.3389/fendo.2022.914449 |
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