Adrenalectomy approach and outcomes according to surgeon volume

Background: This study assessed the relationship between surgeon volume, operative management, and resource utilization in adrenalectomy. Methods: Isolated adrenalectomies performed within our health system were identified (2016-2021). Highvolume surgeons were defined as those performing >= 6 cases/year. Outcomes included indication for surgery, perioperative outcomes, and costs. Results: Of 476 adrenalectomies, high-volume surgeons (n = 3) performed 394, while low-volume surgeons (n = 12) performed 82. High-volume surgeons more frequently operated for pheochromocytoma (19% vs. 16%, p < 0.001) and less frequently for metastasis (6.4% vs. 23%, p < 0.001), more frequently used laparoscopy (95% vs. 80%, p < 0.001), and had lower operative supply costs ($1387 vs. $1,636, p = 0.037). Additionally, laparoscopic adrenalectomy was associated with shorter length of stay (-3.43 days, p < 0.001), lower hospitalization costs (-$72,417, p < 0.001), and increased likelihood of discharge to home (OR 17.03, p = 0.008). Conclusions: High-volume surgeons more often resect primary adrenal pathology and utilize laparoscopy. Laparoscopic adrenalectomy is, in turn, associated with decreased healthcare resource utilization.