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

Rafael R H Martin1, Jorge L Gomez-Mayorga1, Anastasia K Bogdanovski1

  • 1Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

World Journal of Surgery
|August 13, 2025
PubMed
Summary

Outpatient minimally invasive adrenalectomy is as safe as inpatient procedures, with no significant differences in 30-day complications or readmissions. This finding supports the potential expansion of same-day discharge protocols for adrenal surgery.

Keywords:
meta‐analysisminimally invasive adrenal surgeryoutpatientsame‐day discharge

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Area of Science:

  • Surgical Oncology
  • Minimally Invasive Surgery
  • Adrenal Gland Disorders

Background:

  • Surgical care advancements enable outpatient protocols for traditionally inpatient procedures, including adrenal surgery.
  • Debate exists regarding the safety and efficacy of outpatient minimally invasive adrenalectomy.
  • PROSPERO Registration CRD42023469240.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis comparing outpatient versus inpatient minimally invasive adrenalectomy.
  • To evaluate the safety and outcomes of same-day discharge protocols for adrenal surgery.

Main Methods:

  • Systematic search of Cochrane, EMBASE, Web of Science, and PubMed databases (September 2023).
  • Inclusion of studies comparing outpatient to inpatient minimally invasive adrenalectomy for primary adrenal diseases.
  • Exclusion of open adrenalectomy, radiofrequency ablation, and metastatic adrenal disease cases.
  • Random effects model for statistical analysis of primary outcomes (30-day complications and readmissions).

Main Results:

  • Analysis of five studies involving 762 outpatient and 15,331 inpatient adrenalectomies.
  • No significant differences in adjusted 30-day readmission rates (OR=0.88; 95% CI 0.27-2.89; p=0.84).
  • No significant differences in adjusted complication rates (OR=0.68; 95% CI 0.39-1.18; p=0.17).
  • No statistically significant differences in unadjusted outcomes including acute kidney injury, deep vein thrombosis, pneumonia, urinary tract infection, and surgical site infection.

Conclusions:

  • Outpatient minimally invasive adrenalectomy demonstrates comparable safety and outcomes to inpatient procedures.
  • Further research is needed to identify patient characteristics suitable for outpatient protocols.
  • Quasi-experimental methods can help establish comparable baseline groups for future studies.