Outpatient Versus Inpatient Minimally Invasive Adrenalectomy: A Systematic Review and Meta-Analysis

Advances in surgical care have allowed the implementation of outpatient protocols across many traditionally inpatient procedures, including adrenal surgery. However, there is an ongoing debate regarding the safety of outpatient minimally invasive adrenalectomy. This study aims to perform a systematic review and meta-analysis comparing outpatient to inpatient minimally invasive adrenalectomy.

A systematic search for studies comparing outpatient versus inpatient minimally invasive adrenalectomy in September 2023 on Cochrane, EMBASE, Web of Science, and PubMed was performed. Inclusion criteria were studies comparing outpatient to inpatient minimally invasive adrenalectomy for primary adrenal diseases. Exclusion criteria were studies including open adrenalectomy, radiofrequency ablation, and patients with metastasis to the adrenals. Primary outcomes were 30-day complications and readmissions. Statistical analysis was performed with a random effects model.

Five studies comprising 762 outpatient and 15,331 inpatient adrenalectomies met inclusion criteria. Pooled analysis showed no differences in adjusted 30-day readmission (OR = 0.88; 95% CI 0.27-2.89; p = 0.84; I² = 67%) and complication rates (OR = 0.68; 95% CI 0.39-1.18; p = 0.17; I² = 32%). Similarly, no statistically significant differences were found for unadjusted outcomes of acute kidney injury, deep vein thrombosis, pneumonia, urinary tract infection, and surgical site infection.

Our study demonstrated no differences in outcomes between outpatient and inpatient minimally invasive adrenalectomy. Future studies should address baseline characteristics that render patients more suitable for outpatient protocols and aim to establish comparable groups at baseline through quasi-experimental methods.

PROSPERO Registration (CRD42023469240).