Open and Laparoscopic Adrenalectomy: Analysis of the National Surgical Quality Improvement Program

James Lee, Mahmoud El-Tamer, Tracy Schifftner, Florence E. Turrentine, William G. Henderson, Shukri Khuri, John B. Hanks, William B. Inabnet

Research output: Contribution to journalArticlepeer-review

147 Scopus citations

Abstract

Background: Numerous series demonstrate the benefits of laparoscopic versus open adrenalectomy, but fail to adjust for confounding factors. This study uses the Veterans Affairs National Surgical Quality Improvement Program database to compare these two approaches, adjusting for baseline differences. Study Design: Laparoscopic (n = 358) and open (n = 311) adrenalectomy data were collected at 123 Department of Veterans Affairs and 14 university hospitals from October 1, 2001 to September 30, 2004. Preoperative characteristics, operative data, and 30-day outcomes were compared using the chi-square or Fisher's exact test for categorical variables and the t-test for continuous variables. Unadjusted odds ratio (OR) and 95% confidence interval (CI) were computed for the effect of operative approach on postoperative morbidity. Adjusted odds ratios and 95% CI were computed for this same effect, adjusting for variables that were predictive of outcomes or imbalanced at baseline. Data are reported as means ±SD, unless otherwise indicated. Results: Patients undergoing open adrenalectomy were more likely to be older (57.8 ± 11.9 years versus 53.5 ± 13.2 years, p < 0.0001), harbor malignancy (44.5% versus 13.5%, p < 0.0001), have higher American Society of Anesthesiologists classifications (p = 0.0037), smoke (35.4% versus 22.6%, p = 0.0003), and have lower serum albumin levels (3.9 ± 0.5 g/dL versus 4.0 ± 0.5 g/dL, p = 0.0241). Open procedures had increased operative times (3.9 ± 1.8 hours versus 2.9 ± 1.3 hours, p < 0.0001), transfusion requirements (0.7 ± 1.8 U versus 0.1 ± 0.5 U, p < 0.0001), reoperations (4.8% versus 1.4%, p = 0.0094), length of stay (9.4 ± 11.0 days versus 4.1 ± 4.7 days, p < 0.0001) and 30-day morbidity rates (17.4% versus 3.6%, p < 0.0001) with unadjusted and adjusted odds ratio (95% CI) of 5.52 (2.94, 10.33), and 3.97 (1.92, 8.22), respectively. Open procedures resulted in more pneumonia, unplanned intubation, unsuccessful ventilator wean, systemic sepsis, cardiac arrest, renal insufficiency, and wound infections. Conclusions: Even after adjustment for confounding factors, 30-day morbidity was much higher for patients having open adrenalectomy.

Original languageEnglish
Pages (from-to)953-959
Number of pages7
JournalJournal of the American College of Surgeons
Volume206
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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