Abstract
Minimally invasive approaches have dramatically reduced morbidity associated with adrenalectomy. There has been concern that an increased frequency of adrenal imaging along with the advantages of less morbidity could influence the indications for adrenalectomy. We tested the hypothesis that adrenalectomy has become more common over time and that benign diseases have been increasingly represented among procedural indications. The Nationwide Inpatient Sample (NIS) database was utilized to determine the incidence of adrenalectomy and the associated surgical indications in the United States between 1988 and 2000. All discharged patients were identified whose primary ICD-9-CM procedure code was for adrenalectomy, regardless of the specific surgical approach (laparoscopic adrenalectomy was not reliably coded). This subset was then queried for associated ICD-9-CM diagnostic codes. Linear regression and t-tests were utilized to determine the significance of trends. The total number of adrenalectomies increased significantly, from 12.9 per 100,000 discharges in 1988 to 18.5 per 100,000 discharges in 2000 (p = 0.000003). The total number of adrenalectomies with a primary ICD-9-CM code for malignant adrenal neoplasm did not increase significantly: from 1.2 per 100,000 discharges in 1988 to 1.6 per 100,000 discharges in 2000 (p = 0.47). The total number of adrenalectomies with a primary ICD-9-CM diagnostic code for benign adrenal neoplasm increased significantly, from 2.8 per 100,000 discharges in 1988 to 4.8 per 100,000 discharges in 2000 (p = 0.00002). The average percentage of adrenalectomies performed for malignant neoplasm was significantly higher during the period 1988–1993 when compared to 1994–2000 (11% vs. 9%; p = 0.002). The average percentage of adrenalectomies performed for benign neoplasm was significantly lower during 1988–1993 when compared to 1994–2000 (25% vs. 28%; p = 0.015). Adrenalectomy is being performed with increasing frequency. This is associated with an increase in the proportion of adrenalectomies performed for benign neoplasms. Assuming no significant change in disease prevalence during the study period, these data suggest that indications for adrenalectomy may have changed somewhat over that period.
Similar content being viewed by others
References
M Gagner A Lacroix E Bolte (1992) ArticleTitleLaparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma N. Engl. J. Med. 327 1033 Occurrence Handle1:STN:280:By2A1M%2FgtFQ%3D Occurrence Handle1387700
H Bonjer J Lange G Kazemier et al. (1997) ArticleTitleComparison of three techniques for adrenalectomy Br. J. Surg. 84 679–682 Occurrence Handle10.1046/j.1365-2168.1997.02655.x Occurrence Handle1:STN:280:ByiA3MrnsF0%3D Occurrence Handle9171764
Q Duh A Siperstein O Clark et al. (1996) ArticleTitleLaparoscopic adrenalectomy: comparison of the lateral and posterior approaches Arch. Surg. 131 870–876 Occurrence Handle1:STN:280:BymA3MnosVA%3D Occurrence Handle8712912
J Heerden ParticleVan (1998) ArticleTitleEndocrine surgery J. Am. Coll. Surg. 186 141–148 Occurrence Handle10.1016/S1072-7515(98)00066-0 Occurrence Handle9482616
N Dudley B Harrison (1999) ArticleTitleComparison of open posterior versus transperitoneal laparoscopic adrenalectomy Br. J. Surg. 86 656–660 Occurrence Handle10.1046/j.1365-2168.1999.01110.x Occurrence Handle1:STN:280:DyaK1M3ptV2itw%3D%3D Occurrence Handle10361189
G Thompson C Grant J Heerden Particlevan et al. (1997) ArticleTitleLaparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients Surgery 122 1132–1136 Occurrence Handle10.1016/S0039-6060(97)90218-X Occurrence Handle1:STN:280:DyaK1c%2Foslyjuw%3D%3D Occurrence Handle9426429
T Imai G Thompson T Kikumori et al. (1999) ArticleTitleA case-controlled study of laparoscopic compared with open lateral adrenalectomy Am. J. Surg. 178 50–54 Occurrence Handle10.1016/S0002-9610(99)00126-9 Occurrence Handle1:STN:280:DyaK1MzotlOjsQ%3D%3D Occurrence Handle10456703
J Jacobs R Goldstein R Geer (1997) ArticleTitleLaparoscopic adrenalectomy: new standard of care Ann. Surg. 225 495–501 Occurrence Handle10.1097/00000658-199705000-00006 Occurrence Handle1:STN:280:ByiA3snkt1I%3D Occurrence Handle9193177
C Smith C Weber J Amerson (1999) ArticleTitleLaparoscopic adrenalectomy: new gold standard World J. Surg. 23 389–396 Occurrence Handle1:STN:280:DyaK1M7lsFeisA%3D%3D Occurrence Handle10030863
R Prinz (1995) ArticleTitleA comparison of laparoscopic and open adrenalectomies Arch. Surg. 143 489–494
M Barreca L Presenti C Renzi et al. (2003) ArticleTitleExpectations and outcomes when moving from open to laparoscopic adrenalectomy: multivariate analysis World J. Surg. 27 223–228 Occurrence Handle12616441
L Brunt G Doherty J Norton et al. (1996) ArticleTitleLaparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms J. Am. Coll. Surg. 183 1–10 Occurrence Handle1:STN:280:BymB28bkt1I%3D Occurrence Handle8673301
D Graham C McHenry (1998) ArticleTitleThe adrenal incidentaloma: guidelines for evaluation and recommendations for management Surg. Oncol. Clin. N. Am. 7 749–764 Occurrence Handle1:STN:280:DyaK1cvgs1eisA%3D%3D Occurrence Handle9735132
M Gagner G Breton D Pharand et al. (1996) ArticleTitleIs laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery 120 1076–1080 Occurrence Handle1:STN:280:ByiC3MnktFQ%3D Occurrence Handle8957498
P Miccoli M Raffaelli P Berti et al. (2002) ArticleTitleAdrenal surgery before and after the introduction of laparoscopic adrenalectomy Br. J. Surg. 89 779–782 Occurrence Handle10.1046/j.1365-2168.2002.02110.x Occurrence Handle1:STN:280:DC%2BD383ovVWjtw%3D%3D Occurrence Handle12027991
D Wood L Delbridge T Reeve (1987) ArticleTitleSurgery for adrenal tumors. Is operation for the small incidental tumors appropriate? ANZ J. Surg. 57 739–742 Occurrence Handle1:STN:280:BieC3cnitVI%3D
S Sidhu C Bambrach S Pillinger et al. (2002) ArticleTitleChanging patterns of adrenalectomy at a tertiary referral centre 1970-2000 ANZ J. Surg. 72 463–466 Occurrence Handle10.1046/j.1445-2197.2002.02454.x Occurrence Handle12123500
J Sosa R Udelsman (1999) ArticleTitleImaging of the adrenal gland Surg. Oncol. Clin. N. Am. 8 109–127 Occurrence Handle1:STN:280:DyaK1M%2Fkt1WnsA%3D%3D Occurrence Handle9824364
M Herrera C Grant J Heerden Particlevan et al. (1991) ArticleTitleIncidentally discovered adrenal tumors: an institutional perspective Surgery 110 1014–1021 Occurrence Handle1:STN:280:By2D1c%2FpvVI%3D Occurrence Handle1745970
WT Shen RC Lim AE Siperstein et al. (1999) ArticleTitleLaparoscopic versus open adrenalectomy for the treatment of primary hyperaldosteronism Arch. Surg. 134 628–632 Occurrence Handle10.1001/archsurg.134.6.628 Occurrence Handle1:STN:280:DyaK1M3psVaqsA%3D%3D Occurrence Handle10367872
C Steiner A Elixhauser J Schnaier (2002) ArticleTitleThe healthcare cost and utilization project: an overview Effective Clin Pract 5 143–151
Public Health Service. HCFA: International Classification of Diseases, 9th Revision, Clinical Modification, Washington, DC, U.S. Department of Health and Human Resources, 1991
SR Schell MA Talamini R Udelsman (1999) ArticleTitleLaparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost-effectiveness Surg. Endosc. 13 30–34 Occurrence Handle10.1007/s004649900892 Occurrence Handle1:STN:280:DyaK1M%2FovVaqug%3D%3D Occurrence Handle9869684
LM Brunt JF Moley GM Doherty et al. (2001) ArticleTitleOutcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors Surgery 130 629–635 Occurrence Handle10.1067/msy.2001.116920 Occurrence Handle1:STN:280:DC%2BD3Mrls1WhtA%3D%3D Occurrence Handle11602893
JA Cowan JB Dimick RM Wainess et al. (2003) ArticleTitleRuptured thoracoabdominal aortic aneurysm treatment in the United States: 1988 to 1998 J. Vasc. Surg. 38 319–322 Occurrence Handle10.1016/S0741-5214(03)00227-1 Occurrence Handle12891114
JB Dimick JA Cowan PK Henke et al. (2003) ArticleTitleHospital volume-related differences in aorto-bifemoral bypass operative mortality in the United States J. Vasc. Surg. 37 970–975 Occurrence Handle10.1067/mva.2003.207 Occurrence Handle12756341
J Shen (2002) ArticleTitleSeverity of illness, treatment environments, and outcomes of treating acute myocardial infarction for Hispanic Americans Ethn. Dis. 12 488–498 Occurrence Handle12477134
R Chang A Chen T Klitzner (2002) ArticleTitleClinical management of infants with hypoplastic left heart syndrome in the United States, 1988-1997 Pediatrics 110 292–298 Occurrence Handle10.1542/peds.110.2.292 Occurrence Handle12165581
H Xiao E Campbell K Song (2002) ArticleTitleA trend analysis of organ transplantation among ethnic groups J. Natl. Med. Assoc. 94 15–20 Occurrence Handle11837347
P Nietart M Silverstein R Silver (2001) ArticleTitleHospital admissions, length of stay, charges, and in-hospital death among patients with systemic sclerosis J. Rheumatol. 28 2031–2037 Occurrence Handle11550971
T Howard L Hoffman P Stang et al. (2000) ArticleTitleRespiratory syncytial virus pneumonia in the hospital setting: length of stay, charges, and mortality J. Pediatr. 137 227–232 Occurrence Handle10.1067/mpd.2000.107525 Occurrence Handle1:STN:280:DC%2BD3cvjvVWksg%3D%3D Occurrence Handle10931416
S Wells (1998) ArticleTitleThe role of laparoscopic surgery in adrenal disease J. Clin. Endocrinol. Metab. 83 3041–3043 Occurrence Handle10.1210/jc.83.9.3041 Occurrence Handle1:CAS:528:DyaK1cXmt1ehtLk%3D Occurrence Handle9745398
J Norton (1998) ArticleTitleLaparoscopic versus open adrenalectomy J. Clin. Endocrinol. Metab. 83 3048–3049 Occurrence Handle10.1210/jc.83.9.3048
S Mugiya K Suzuki H Masuda et al. (1996) ArticleTitleLaparoscopic adrenalectomy for nonfunctioning adrenal tumors J. Endourol. 10 539–541 Occurrence Handle1:STN:280:ByiC38fhvFE%3D Occurrence Handle8972789
J Rutherford R Gordon M Stowasser et al. (1995) ArticleTitleLaparoscopic adrenalectomy for adrenal tumors causing hypertension and for “incidentaloma” of the adrenal on computerized tomography scanning Clin. Exp. Pharmacol. Physiol. 22 490–492 Occurrence Handle1:CAS:528:DyaK2MXntVWht78%3D Occurrence Handle8582113
D Hale M Molloy R Pearl et al. (1997) ArticleTitleAppendectomy: a contemporary appraisal Ann. Surg. 225 252–261 Occurrence Handle10.1097/00000658-199703000-00003 Occurrence Handle1:STN:280:ByiB3MzovFU%3D Occurrence Handle9060580
Acknowledgments.
The authors gratefully acknowledge Erika Saunders, M.D., in the Department of Psychiatry at the University of Michigan, for her assistance with data analysis and statistical calculations.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Saunders, B., Wainess, R., Dimick, J. et al. Trends in Utilization of Adrenalectomy in the United States: Have Indications Changed?. World J. Surg. 28, 1169–1175 (2004). https://doi.org/10.1007/s00268-004-7619-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-004-7619-6