{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T02:48:00Z","timestamp":1785206880186,"version":"3.55.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Open Access Publication Fund of the University of Wuerzburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Adrenal resections are rare procedures of a heterogeneous nature. While recent European guidelines advocate a minimum annual caseload for adrenalectomies (6 per surgeon), evidence for a volume\u2013outcome relationship for this surgery remains limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A retrospective analysis of all adrenal resections in Germany between 2009 and 2017 using hospital billing data was performed. Hospitals were grouped into three tertiles of approximately equal patient volume.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Descriptive, univariate, and multivariate analyses were applied to identify a possible volume\u2013outcome relationship (complications, complication management, and mortality).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Around 17 040 primary adrenal resections were included. Benign adrenal tumors (n = 8,213, 48.2%) and adrenal metastases of extra-adrenal malignancies (n = 3582, 21.0%) were the most common diagnoses. Six hundred and thirty-two low-volume hospitals performed an equal number of resections as 23 high-volume hospitals (median surgeries\/hospital\/year 3 versus 31, P &amp;lt; .001). Complications were less frequent in high-volume hospitals (23.1% in low-volume hospitals versus 17.3% in high-volume hospitals, P &amp;lt; .001). The most common complication was bleeding in 2027 cases (11.9%) with a mortality of 4.6% (94 patients). Overall in-house mortality was 0.7% (n = 126). Age, malignancy, an accompanying resection, complications, and open surgery were associated with in-house mortality. In univariate analysis, surgery in high-volume hospitals was associated with lower mortality (OR: 0.47, P &amp;lt; .001). In a multivariate model, the tendency remained equal (OR: 0.59, P = .104). Regarding failure to rescue (death in case of complications), there was a trend toward lower mortality in high-volume hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The annual caseload of adrenal resections varies considerably among German hospitals. Our findings suggest that surgery in high-volume centers is advantageous for patient outcomes although fatal complications are rare.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvac013","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:07:22Z","timestamp":1673309242000},"page":"39-47","source":"Crossref","is-referenced-by-count":10,"title":["Volume\u2013outcome relationship in adrenal surgery from 2009-2017 in Germany\u2014a retrospective study"],"prefix":"10.1093","volume":"188","author":[{"given":"Konstantin L","family":"Uttinger","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"},{"name":"Department of Visceral, Transplant, Thoracic and Vascular Surgery at Leipzig University Hospital , 04103 Leipzig , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Reibetanz","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Diers","sequence":"additional","affiliation":[{"name":"Department of Internal Medicne, Marienkrankenhaus , 22087 Hamburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Baum","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital , 62196 Heidelberg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Pietryga","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Hendricks","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Sch\u00fctze","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolas","family":"Baumann","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Wiegering","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Ped. Hematology, Oncology and Stem Cell Transplantation, at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Lock","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Dischinger","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital W\u00fcrzburg , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Seyfried","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6170-6398","authenticated-orcid":false,"given":"Martin","family":"Fassnacht","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital W\u00fcrzburg , 97080 W\u00fcrzburg , Germany"},{"name":"Comprehensive Cancer Center Mainfranken, University of W\u00fcrzburg Medical Center , 97080 W\u00fcrzburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph-Thomas","family":"Germer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at W\u00fcrzburg University Hospital , 97080 W\u00fcrzburg , Germany"},{"name":"Comprehensive Cancer Center Mainfranken, University of W\u00fcrzburg Medical Center , 97080 W\u00fcrzburg , 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