门诊微创肾上腺切除术的使用趋势：基于人群的分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-13 DOI:10.1016/j.amjsurg.2025.116247

J. Walker Rosenthal , Caitlin B. Finn , Jasmine Hwang , James E. Sharpe , Shane T. Williams , Lauren N. Krumeich , Doug L. Fraker , Heather Wachtel , Rachel R. Kelz

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引用次数: 0

摘要

目的以人群为基础，研究门诊肾上腺切除术的时间趋势和结果。方法采用2016-2020年医疗成本与利用项目的国家住院和国家门诊手术数据库进行回顾性队列研究。接受微创肾上腺切除术的患者使用账单代码进行识别。主要暴露是由住院时间定义的入院状态。结果包括入院类型、再入院率和费用的时间趋势。结果4431例肾上腺切除术中，51.3%在门诊进行。大多数患者在夜间观察，只有100例患者（2.3%）当天出院。门诊肾上腺切除术每年从2016年的44.1%增加到2020年的59.2% (p <；0.01)。中位数成本相似，风险调整后的边际差异为179美元(当日：9565美元vs隔夜9491美元；p = 0.81)。同一天和过夜住院的再入院几率相似(OR 0.18；p = 0.10)。结论在费用和再入院率相似的情况下，患者选择和外科医生的专业知识应继续指导当天肾上腺切除术的决策。

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Trends in use of outpatient minimally-invasive adrenalectomy: A population-based analysis

Purpose

To examine temporal trends and outcomes of outpatient adrenalectomy in a population-based sample.

Methods

We performed a retrospective cohort study using the Healthcare Cost and Utilization Project's State Inpatient and State Ambulatory Surgery Databases, 2016–2020. Patients undergoing minimally invasive adrenalectomy were identified using billing codes. The primary exposure was admission status defined by length of stay. Outcomes included temporal trend in admission type, readmission rates and costs.

Results

Among 4431 adrenalectomies, 51.3 % were performed in the outpatient setting. The majority were observed overnight with only 100 patients (2.3 %) discharged same-day. Outpatient adrenalectomy increased annually from 44.1 % in 2016 to 59.2 % in 2020 (p < 0.01). Median costs were similar with a risk-adjusted marginal difference of $179 (same-day: $9565 vs overnight $9491; p = 0.81). Odds of readmission were similar between same-day and overnight stays (OR 0.18; p = 0.10).

Conclusion

Given similar costs and readmission rates, case selection and surgeon expertise should continue to guide decision-making on same-day adrenalectomy.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.