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Published on: January 17, 2018
Association Between Surgical Indication and Outcomes for Outpatient Adrenalectomy
Griffin Price1, Jessica Fazendin1, John R Porterfield1
1Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Introduction:
Despite a favorable risk-benefit profile, inpatient admission postoperatively for minimally invasive adrenalectomy (MIA) has remained common. Prior studies have shown that outpatient MIA was not associated with an increased 30-day complications or readmission. However, this has not been explored in-depth by adrenalectomy indication. We aimed to examine whether the safety profile of outpatient MIA varies by adrenal indication.
Materials And Methods:
Clinicopathologic parameters were examined for all MIAs entered into an adrenal database at our institution from 2012 to 2021. Predictor variables included patient demographics, surgical indication, and operative time. Outcomes were 30-day emergency department visit, readmission, and complication rates between surgical indications, comparing outpatient and inpatient groups. Statistical analyses were performed using Kruskal-Wallis, Wilcoxon, Mann-Whitney, and Chi-squared tests, as appropriate.
Results:
A total of 185 MIA patients were included. Outpatient MIA was performed in 53 patients (28.6%). Outpatient discharge post-MIA was related to both surgical indication and operative time. Pheochromocytoma (PC) patients were less likely to be discharged as an outpatient postoperatively when compared to all other indications (13.0% versus 33.8%, P = 0.007). Among all patients with operations 2-3 h in length, PC patients were less likely to be discharged home as an outpatient (10% versus 33.3%, P = 0.040). No significant differences were identified between outpatient and inpatient MIA groups for complications, emergency department visits, or readmission (P > 0.05 for all). Only six outpatient MIA patients had any complication (11.3%) and six were readmitted (11.3%).
Conclusions:
Outpatient MIA was demonstrated to be associated with similar, low complication and readmission rates compared to inpatient MIA, although it was used less often for patients with PC or prolonged operative times. Our study highlights potential evidence that outpatient MIA can be safely used in selected patients across all indications for adrenal surgery.
Insights
Outpatient minimally invasive adrenalectomy (MIA) is safe across all indications, showing similar low complication rates to inpatient procedures. However, it is less frequently used for pheochromocytoma (PC) or longer surgeries.
Area of Science:
- Endocrine Surgery
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Inpatient admission after minimally invasive adrenalectomy (MIA) remains common despite a favorable risk-benefit profile.
- Previous research suggests outpatient MIA is safe, but its applicability across different surgical indications requires deeper investigation.
Purpose of the Study:
- To evaluate if the safety of outpatient MIA differs based on the surgical indication for adrenalectomy.
- To compare complication and readmission rates for outpatient versus inpatient MIA across various indications.
Main Methods:
- A retrospective review of 185 patients undergoing MIA from 2012 to 2021.
- Analysis of clinicopathologic parameters, surgical indications, and operative times.
- Comparison of 30-day outcomes (emergency department visits, readmissions, complications) between outpatient and inpatient groups stratified by indication.
Main Results:
- Outpatient MIA was performed in 28.6% of patients and was associated with surgical indication and operative time.
- Pheochromocytoma (PC) patients were less likely to be discharged as outpatients (13.0% vs. 33.8%, P=0.007).
- No significant differences in 30-day complications, ED visits, or readmissions were found between outpatient and inpatient MIA groups (P>0.05).
Conclusions:
- Outpatient MIA demonstrates comparable low complication and readmission rates to inpatient MIA.
- Outpatient MIA is underutilized in patients with PC or longer operative times.
- Selected patients across all adrenal surgery indications may benefit from outpatient MIA.
