Login to Access Video or Poster Abstract: MP37-11
Sources of Funding: none

Introduction

For elective adrenalectomy, the decision between laparoscopic versus open adrenalectomies is made largely based on surgeon preference, and these surgeries are performed by both general surgeons and urologists. Here, we sought to examine the perioperative outcomes of laparascopic versus open elective adrenalectomies when performed by a urologic surgeon.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2012) was queried using Current Procedural Terminology adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Only surgeries performed by urologic surgeons were included. Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. pOT and pLOS were defined as an operating time and a hospital length-of-stay greater than the 75th percentile, respectively (pOT=193 minutes and pLOS>4 days).

Results

Two hundred ninety-one patients who underwent adrenalectomy were identified. Of those, 73 underwent open and 218 underwent laparoscopic elective adrenalectomy. Laparoscopic approach was utilized more frequently in patients with a body mass index (BMI) of >25 (p=0.0155), yet approach was not associated with ASA score (p=0.3897). The overall complication rate was 6.2% (18/291): 9.6% for open approach and 4.6% for laparoscopic (p=0.1468). When compared to open, laparoscopic adrenalectomies were associated with shorter operative time (p<0.0001), and shorter length of stay (p<0.0001). Laparoscopic approach was also associated with lower rates of postoperative deep vein thrombosis (p=0.0142) and decreased need for blood transfusions (p<0.0001). However, there was no significant difference in need to return for reoperation (p=0.1277).

Conclusions

Despite its more common utilization in overweight individuals, laparoscopic adrenalectomy is faster and results in shorter length of stay, decreased need for blood transfusions, and fewer deep vein thromboses. Otherwise, the 30-day post-operative outcomes between the laparoscopic and open approaches are comparable. Therefore, laparoscopic adrenalectomy should be attempted when possible.

Funding

none