Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project

Abstract Background Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvemen...

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Bibliographic Details
Published in:The Journal of surgical research 2013-09, Vol.184 (1), p.216-220
Main Authors: Elfenbein, Dawn M., MD, MPH, Scarborough, John E., MD, Speicher, Paul J., MD, Scheri, Randall P., MD
Format: Article
Language:English
Subjects:
Adrenal Gland Neoplasms - mortality
Adrenal Gland Neoplasms - surgery
Adrenalectomy - methods
Adrenalectomy - mortality
Adrenalectomy - standards
Adult
Aged
Benchmarking
Databases, Factual - statistics & numerical data
Female
Hospital Mortality
Humans
International Classification of Diseases
Laparoscopic adrenalectomy
Laparoscopy - standards
Laparoscopy - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Morbidity
NSQIP
Open adrenalectomy
Postoperative Complications - mortality
Quality Improvement
Retrospective Studies
Surgery
Survival Rate
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Summary:Abstract Background Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis was to compare the 30-d outcomes after laparoscopic versus open adrenalectomy using this data source. Methods The ACS-NSQIP Participant User Files for 2005–2010 were used for this retrospective analysis, which included all patients with (1) a primary Current Procedural Terminology code for open or laparoscopic adrenalectomy and (2) a postoperative International Classification of Diseases, Ninth Revision ( ICD-9 ) code for adrenal gland pathology. Primary outcomes were 30-d postoperative mortality, overall complication rate, and length of postoperative hospitalization. The association between surgical approach and primary outcomes were determined after adjusting for a comprehensive array of patient- and procedure-related factors. Results A total of 3100 patients were included for analysis (644 undergoing open versus 2456 undergoing laparoscopic adrenalectomy). Patients undergoing a laparoscopic procedure had significantly lower postoperative morbidity and shorter length of stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors. Similar findings were demonstrated for all indications, including malignancy. Conclusions To our knowledge, the present study represents the largest comparison to date of laparoscopic versus open adrenalectomy. Our findings suggest that the laparoscopic approach is associated with sizeable reductions in postoperative morbidity and length of postoperative hospitalization.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2013.04.014