LAUSR

Although there is surgeon volume-outcome effect in adrenal surgery the threshold for ‘high volume’ surgeon remains controversial. This retrospective cohort study of the UKRETS database explores this issue further. Adrenal data on adults aged 18–90 years from 2004 to 2021 was analysed. Outcomes included postoperative complications, post-operative, length of stay (LOS) and mortality. Factors included in multivariable analysis were patient age, gender, diagnosis, surgical approach, anatomy, and surgeon volume. Cases with missing data on any variable and LOS > 60 days were excluded. Of 6174 operations, 4464 (72.3%) cases were analysed. Postoperative complications occurred in 418/4064 (9.4%) and mortality in 14/4064 (0.3%). Median LOS was 3 (IQR 2-5) days. Co-variables significantly (p<0.05) associated with adverse outcomes were: postoperative complications - age [OR 1.02 (95% CI 1.01-1.03)], adrenal cancer [OR 1.64 (95% CI 1.14-2.36)], bilateral surgery [OR 1.66 (95% CI 1.03-2.69)] and surgeon volume [OR 0.98 (95% CI 0.96-0.99)]; mortality - age [OR 1.08 (95% CI 1.03-1.13)], laparoscopic approach [OR 0.08 (95% CI 0.02-0.27)] and bilateral surgery [OR 6.93 (95% CI 1.40-34.34)] and LOS (standardised beta co-efficient) - male sex (-0.03), age (0.09), phaeochromocytoma (0.07), adrenal cancer (0.08), bilateral surgery (0.11), laparoscopic approach (-0.40) and surgeon volume (-0.06). Surgery for adrenal cancer and bilateral tumours could be restricted to high volume surgeons, but the threshold still needs to be defined.