Pediatric Adrenalectomy: National practice patterns, admission outcomes, and costs
*Varvara Mironova, James M Healy, *Doruk E. Ozgediz, Emily R. Christison-Lagay, *David H. Stitelman, Robert A. Cowles, Michael G. Caty, *Daniel G. Solomon
Yale, New Haven, CT
Objective: Pediatric adrenalectomy is uncommon, and data are incomplete regarding demographics and clinical outcomes on a national scale. Aim: characterize population-level patterns, costs, and outcomes among pediatric patients undergoing adrenalectomy for benign and malignant adrenal masses.
Design: Retrospective analysis 2012 Kids’ Inpatient Database (n=3,200,000) yielded 346 admissions associated with unilateral, bilateral, or partial adrenalectomy. Non-primary adrenal disorders were excluded to select 232 cases of malignant (n=138) or benign/uncertain malignant potential (n=94). SPSS was used for statistical analysis.
Setting: National sample
Participants: Pediatric inpatients undergoing adrenalectomy
Interventions: none
Main Outcome Measures: Patient demographics, hospital characteristics, and outcomes.
Results: Mean age was 7.23, SD 6.73, median 4. Malignant adrenal neoplasia affects younger children than benign disease [4.0 (3.2-4.8) vs 13.0 (12.5-15.2) p<0.001] with a slight male predominance in malignant disease (p=0.068). No significant difference between length of stay for type of adrenalectomy, however hospitalization was significantly longer for malignant vs benign/uncertain disease [mean 6.9 (5.7-8.2) vs 5.1 (3.9-6.2) p=0.002]. Post-operative total parenteral nutrition (TPN) (p=0.018), central line requirement (p=0.005), and discharge with services or to facility (p<0.001) were significantly higher for malignant disease. No mortalities were reported. Higher total charges were reported for malignant vs. benign/uncertain tumors [$90.9K (72.2K-109.6K) vs. $60.1K (50.1K-70.1K) p=0.001]. The vast majority of adrenalectomies in the US are performed in cities or counties with populations >250,000 and most are performed in or around urban areas with populations of >1million.
Conclusion: This study represents a population-level analysis of pediatric adrenalectomy in the US. Pediatric patients with malignant adrenal neoplasia require longer hospitalization, services on discharge, increased charges, and increased need for TPN. There is a national trend towards pediatric adrenalectomy in urban populous centers.
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