HHS Public Access Author manuscript Author Manuscript
J Gastrointest Surg. Author manuscript; available in PMC 2016 July 19. Published in final edited form as: J Gastrointest Surg. 2015 December ; 19(12): 2154–2161. doi:10.1007/s11605-015-2917-x.
Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma
Author Manuscript
Javier Valero-Elizondo1, Yuhree Kim1, Jason D. Prescott1, Georgios A. Margonis1, Thuy B. Tran2, Lauren M. Postlewait3, Shishir K. Maithel3, Tracy S. Wang4, Jason A. Glenn4, Ioannis Hatzaras5, Rivfka Shenoy5, John E. Phay6, Kara Keplinger6, Ryan C. Fields7, Linda X. Jin7, Sharon M. Weber8, Ahmed Salem8, Jason K. Sicklick9, Shady Gad9, Adam C. Yopp10, John C. Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C. Solorzano12, Colleen M. Kiernan12, Konstantinos I. Votanopoulos13, Edward A. Levine13, George A. Poultsides2, and Timothy M. Pawlik1,14 Timothy M. Pawlik: [email protected]
Author Manuscript
1Department
of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
2Department
of Surgery, Stanford University School of Medicine, Stanford, CA, USA
3Department
of Surgery, Emory University, Atlanta, GA, USA
4Department
of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
5Department
of Surgery, New York University School of Medicine, New York, NY, USA
6Department
of Surgery, The Ohio State University, Columbus, OH, USA
7Department
of Surgery, Washington University School of Medicine, St. Louis, MO, USA
8Department
of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
9Department
of Surgery, University of California San Diego, San Diego, CA, USA
10Department
of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
11Department
of Surgery, University of California San Francisco, San Francisco, CA, USA
12Department
of Surgery, Vanderbilt University, Nashville, TN, USA
13Department
of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
Author Manuscript
14Division
of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
Abstract Background—Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to
Correspondence to: Timothy M. Pawlik, [email protected]. Funding/support None
Valero-Elizondo et al.
Page 2
Author Manuscript
define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. Methods—Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission.
Author Manuscript
Results—Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3–4 (n=85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n=38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75–13.61); P=0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37–6.46); P=0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16– 6.51); P=0.02), complication (OR, 1.91 (95 % CI, 1.20–3.05); P=0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88–9.01); P700 mL: OR, 2.75 (95 % CI, 1.16–6.51); P=0.02). Patients who experienced complications also had higher odds of readmission (OR, 1.91 (95 % CI, 1.20– 3.05): P=0.007) compared with patients who did not have a complication. Specifically, patients with either grades 1–2 complications (OR, 3.45 (95 % CI, 1.46–8.14); P=0.005) or grades 3–4 complications (OR, 3.11 (95 % CI, 1.13–8.53); P=0.03) had a higher odds of readmission vs. patients with no complications. In addition, prolonged LOS ≥9 days (OR, 4.12 (95 % CI, 1.88–9.01); P700 mL
2.75 (1.16–6.51)
0.02
1.48 (0.53–4.15)
0.76
OR time ≥4 h
2.22 (0.93–5.29)
0.07
–
Surgical approach
Author Manuscript
MIS
1.00 (Reference)
Open
3.67 (0.84–16.11)
0.09
1.99 (0.38–10.47)
1.28 (0.61–2.69)
0.51
–
0.18
–
Tumor size ≥13 cm
1.00 (Reference) 0.42
N stage N0
1.00 (Reference)
N1
2.17 (0.71–6.61)
T stage T1
1.00 (Reference)
T2
1.94 (0.23–16.64)
0.55
–
T3
1.50 (0.17–13.11)
0.71
–
T4
2.15 (0.23–20.23)
0.50
–
Tumor functionality
Author Manuscript
Non-secreting
1.00 (Reference)
Secreting
1.42 (0.68–2.95)
0.35
0.74 (0.29–1.84)
0.51
2.98 (1.37–6.46)
0.006
3.44 (1.34–8.84)
0.01
Metastasis on presentation
1.00 (Reference)
LOS
J Gastrointest Surg. Author manuscript; available in PMC 2016 July 19. Published in final edited form as: J Gastrointest Surg. 2015 December ; 19(12): 2154–2161. doi:10.1007/s11605-015-2917-x.
Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma
Author Manuscript
Javier Valero-Elizondo1, Yuhree Kim1, Jason D. Prescott1, Georgios A. Margonis1, Thuy B. Tran2, Lauren M. Postlewait3, Shishir K. Maithel3, Tracy S. Wang4, Jason A. Glenn4, Ioannis Hatzaras5, Rivfka Shenoy5, John E. Phay6, Kara Keplinger6, Ryan C. Fields7, Linda X. Jin7, Sharon M. Weber8, Ahmed Salem8, Jason K. Sicklick9, Shady Gad9, Adam C. Yopp10, John C. Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C. Solorzano12, Colleen M. Kiernan12, Konstantinos I. Votanopoulos13, Edward A. Levine13, George A. Poultsides2, and Timothy M. Pawlik1,14 Timothy M. Pawlik: [email protected]
Author Manuscript
1Department
of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
2Department
of Surgery, Stanford University School of Medicine, Stanford, CA, USA
3Department
of Surgery, Emory University, Atlanta, GA, USA
4Department
of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
5Department
of Surgery, New York University School of Medicine, New York, NY, USA
6Department
of Surgery, The Ohio State University, Columbus, OH, USA
7Department
of Surgery, Washington University School of Medicine, St. Louis, MO, USA
8Department
of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
9Department
of Surgery, University of California San Diego, San Diego, CA, USA
10Department
of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
11Department
of Surgery, University of California San Francisco, San Francisco, CA, USA
12Department
of Surgery, Vanderbilt University, Nashville, TN, USA
13Department
of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
Author Manuscript
14Division
of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA
Abstract Background—Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to
Correspondence to: Timothy M. Pawlik, [email protected]. Funding/support None
Valero-Elizondo et al.
Page 2
Author Manuscript
define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection. Methods—Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission.
Author Manuscript
Results—Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3–4 (n=85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n=38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75–13.61); P=0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37–6.46); P=0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16– 6.51); P=0.02), complication (OR, 1.91 (95 % CI, 1.20–3.05); P=0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88–9.01); P700 mL: OR, 2.75 (95 % CI, 1.16–6.51); P=0.02). Patients who experienced complications also had higher odds of readmission (OR, 1.91 (95 % CI, 1.20– 3.05): P=0.007) compared with patients who did not have a complication. Specifically, patients with either grades 1–2 complications (OR, 3.45 (95 % CI, 1.46–8.14); P=0.005) or grades 3–4 complications (OR, 3.11 (95 % CI, 1.13–8.53); P=0.03) had a higher odds of readmission vs. patients with no complications. In addition, prolonged LOS ≥9 days (OR, 4.12 (95 % CI, 1.88–9.01); P700 mL
2.75 (1.16–6.51)
0.02
1.48 (0.53–4.15)
0.76
OR time ≥4 h
2.22 (0.93–5.29)
0.07
–
Surgical approach
Author Manuscript
MIS
1.00 (Reference)
Open
3.67 (0.84–16.11)
0.09
1.99 (0.38–10.47)
1.28 (0.61–2.69)
0.51
–
0.18
–
Tumor size ≥13 cm
1.00 (Reference) 0.42
N stage N0
1.00 (Reference)
N1
2.17 (0.71–6.61)
T stage T1
1.00 (Reference)
T2
1.94 (0.23–16.64)
0.55
–
T3
1.50 (0.17–13.11)
0.71
–
T4
2.15 (0.23–20.23)
0.50
–
Tumor functionality
Author Manuscript
Non-secreting
1.00 (Reference)
Secreting
1.42 (0.68–2.95)
0.35
0.74 (0.29–1.84)
0.51
2.98 (1.37–6.46)
0.006
3.44 (1.34–8.84)
0.01
Metastasis on presentation
1.00 (Reference)
LOS
