Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
UPJ INSIGHT Minimally Invasive Adrenalectomy: Trends, Outcomes, Costs, and Impact of Social Determinants of Health
By: Francesco Ditonno, MD,* Rush University Medical Center, Chicago, Illinois, University of Verona, Italy; Antonio Franco, MD,* Rush University Medical Center, Chicago, Illinois, Sant’Andrea Hospital, La Sapienza University, Rome, Italy; Celeste Manfredi, MD, Rush University Medical Center, Chicago, Illinois, Luigi Vanvitelli University, Naples, Italy; Morgan Sturgis, MD, Rush University Medical Center, Chicago, Illinois; Srinivas Vourganti, MD, Rush University Medical Center, Chicago, Illinois; Edward E. Cherullo, MD, Rush University Medical Center, Chicago, Illinois; Marco De Sio, MD, PhD, Luigi Vanvitelli University, Naples, Italy; Francesco Porpiglia, MD, PhD, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy; Cosimo De Nunzio, MD, PhD, Sant’Andrea Hospital, La Sapienza University, Rome, Italy; Alessandro Antonelli, MD, PhD, University of Verona, Italy; Ephrem Olweny, MD, Rush University Medical Center, Chicago, Illinois; Riccardo Autorino, MD, PhD, Rush University Medical Center, Chicago, Illinois | Posted on: 18 Mar 2024
Ditonno F, Franco A, Manfredi C, et al. Minimally invasive adrenalectomy: a population-based analysis of contemporary trends, outcomes, costs, and impact of social determinants of health. Urol Pract. 2024;11(2):293-302.
Study Need and Importance
There has been a notable increase in the incidence of adrenal masses over the past decade. Despite the widespread adoption of minimally invasive surgery (MIS), uncertainty persists regarding the optimal approach for adrenal carcinoma. Existing literature suggests that postoperative outcomes do not differ between urologists and general surgeons. Instead, surgical volume represents a critical factor for successful procedures. Additionally, contemporary practice underscores the significant impact of social determinants of health (SDOH) on determining treatment outcomes. Utilizing the PearlDiver Mariner database, a commercially available, nationwide database of insurance billing records, we performed a population-based analysis of trends and costs and outcomes of adrenalectomies in the United States.
What We Found
In the present study we observed a decrease in the utilization of adrenalectomy over time, with a significant shift towards the adoption of MIS (Figure). Open surgery was associated with higher complications, longer hospital stays, and elevated costs. On the contrary, MIS was more cost-effective than open surgery and was the preferred approach, regardless of the physician’s specialty. We reported comparable outcomes and costs when urologists were compared to general surgeons. At multivariate analysis, SDOH were significant predictors of 60-day postoperative complications.
Limitations
The retrospective design of this study is related to inherent limitations. Moreover, this study relies on administrative data, potentially introducing coding-related biases. However, Current Procedural Terminology and International Classification of Disease codes are internationally standardized, mitigating this source of bias.
Interpretation for Patient Care
The shift towards MIS aligns with its advantages in reducing complications, length of stay, and costs. The study underscores the impact of SDOH on surgical outcomes, emphasizing the need for further investigations into reducing health care disparities. These findings contribute valuable insights for clinicians, suggesting that MIS is the preferred approach for adrenalectomy, regardless of specialty, and highlighting the importance of addressing SDOH to improve patient outcomes.
advertisement
advertisement