Langenbeck s Archives of Surgery | 2019
8th Conference of the European Society of Endocrine Surgeons
Abstract
8th Conference of the European Society of Endocrine Surgeons # Springer-Verlag GmbH Germany, part of Springer Nature 2019 May 16-18 2019, Granada, Spain www.eses2019.org Local Organising Committee: President: Jesús Villar del Moral, General and Digestive Surgery Department, Virgen de las Nieves University Hospital, Granada, Spain Secretary: Nuria Muñoz Pérez Members: Juan Ignacio Arcelus Martínez Joaquín Gómez Ramírez Selene González Martínez Antonio Ríos Zambudio Congress Venue: Palacio de Congresos y Exposiciones Granada Paseo del Violón 18006 Granada Spain SESSION 1 – VOLUME, OUTCOMES AND QUALITY STANDARDS IN ENDOCRINE SURGERY OC1. VOLUME OUTCOMES IN ADRENAL SURGERY: RESULTS FROM THE UKRETS DATABASE Patel N. , Egan R. , Carter B. 2, Scott-Coombes D. , Stechman M. 1 1 University Hospital Wales. Cardiff, Wales, UK 2 Kings College London, UK Patel N.: [email protected] Introduction: Recent UK guidelines have suggested that adrenal surgery should be performed by surgeons undertaking at least 6 adrenalectomies per annum. This is based on recent reports from both the UK and the US. This study examines the validity of this recommendation when applied to UKRETS contributors and to assess for volume outcomes. Methods: The UKRETS database was interrogated for analysis. Outcomes between high volume surgeons (HSV;> or =6 adrenalectomies/annum) and low volume surgeons (LVS;<6/ annum) were compared. Multi-logistic regression, with random effects by surgeon, was used to compare outcomes with annual volume Results From Jan 2005May 2017, 3084 procedures were performed by 36 high volume surgeons, and 343 by 33 low-volume surgeons . Adrenalectomies performed by HVS were more likely to be attempted (80.7% vs. 74.3%; p=0.009) and completed (75.8% vs. 68.8%; p=0.008) laparoscopically, than by LVS. The proportion of malignant tumours removed was greater in the low volume surgeon group (25% (n=71) vs. 18.3% (n=596); p=0.007). Conversion was more likely with LVS (OR 1.65 [95% CI 1.07-2.54]; p=0.020), largely due to conversion of malignant cases (OR 1.86 [95%CI 1.05-3.31]; p=0.030). Risk of reoperation (OR 0.59 [0.084.62]; p=0.620) and readmission (OR 1.01 [0.44-2.35]; p=0.980) were similar between groups. Conclusion: Surgeons performing > or = 6 adrenalectomies per annum have higher rates of laparoscopic surgery and lower conversion rates. Higher rates of malignancy, and subsequent conversion, in the low volume surgeon group are concerning, but did not appear to adversely affect re-operation rates, readmissions, length of stay or in-hospital mortality. OC2. LOWER POSTOPERATIVE MORTALITY OF ADRENAL SURGERY IN HIGH VOLUME CENTRES; A NATION WIDE STUDY (AFCE) Caiazzo R. ; Lenne X 2., Theis D. 2, Menegaux F. 3, Sebag F. , Brunaud L. , Lifante J.C. , Mirallie E. , Bruandet A. 2, Pattou F. , Clement G. 2 1 General Endocrine Surgery, Lille University Hospital 2 Medical information, Lille University Hospital 3 Pitie Salpetriere Hospital, Paris 4 Marseille University Hospital 5 Nancy University Hospital 6 Lyon University Hospital 7 Nantes University Hospital Nantes; Pattou F.: [email protected] Abstract: The relation between center volume and postoperative outcomes The relation between center volume and postoperative outcomes is established for several major surgical procedures but remains debated in adrenal surgery.We took advantage of an unprecedented nationwide dataset for exploring the determinants of postoperative outcomes of adrenal surgery. A total of 9820 patients (55±14 years; F/M ratio 1.1) underwent adrenalectomy between 2012 and 2017 (2.7 per 100,000 inhabitant per year), for benign disease in 6448 , adrenal metastasis in 1811, and primary malignant disease in 1561. These adrenal lesions were secreting in 5284 patients (46.8%). The proportions of adrenal lesions remained unchanged throughout the study period (Fig 1 bd). Total mortality rate was 1.5% (n=147) and CHAID defined two distinct thresholds of hospital volume : 1 and 32 cases per year. The 90 day mortality rate was 4.0% in low volume centres (≤1 per year), 1.6 % in intermediate volume centres (2-31 per year) and 0.9% in high volume centres (≥32 per year) (P< 0.001). Malignancy, older age, comordibidities, hypercorticism and laparotomy were also Langenbeck s Archives of Surgery https://doi.org/10.1007/s00423-019-01817-7