Comparative Analysis of Laparoscopic Adrenalectomy in a High Volume Center Compared to ACS-NSQIP

Karly Lorbeer, Arghavan Salles, MD, PhD, Bruce L Hall, MD, PhD, Yan Yan, PhD, L. Michael Brunt, MD. Washington University

Introduction: Laparoscopic adrenalectomy is a complex operation requiring advanced surgical skills. However, most adrenalectomies in the US are done outside of high volume (HV) centers. We sought to evaluate whether outcomes for laparoscopic adrenalectomy vary at a HV center compared to centers in the ACS-National Surgical Quality Improvement Program (ACS-NSQIP).

Methods and Procedures: Data for all adrenalectomies at the HV center from 2001-2012 were compared to cases from the ACS-NSQIP 2005-2011 database with a CPT code for laparoscopic or open adrenalectomy and an ICD-9 code for adrenal gland pathology. Data were analyzed using univariate and multivariate regression analyses.

Results: As shown in the table, patients in the ACS-NSQIP database were slightly older and had a slightly higher BMI and ASA class than those at the HV center. A greater proportion of cases were performed laparoscopically at the HV center compared to ACS-NSQIP. For laparoscopic cases, patients at the HV center had lower rates of ACS-NSQIP-defined complications compared to patients in the ACS-NSQIP database overall. When we included additional locally-tracked complications such as adrenal insufficiency and retroperitoneal hematoma, the complication rate at the HV center was 8.5%. The rate of conversion to open at the HV center was 4.2% but was not reported in the ACS-NSQIP database. Multivariable regression analysis showed that only higher intraoperative blood loss (OR 1.003) and longer postoperative length of stay (OR 1.358) were associated with increased complications in the HV group whereas age, BMI, operative time and postoperative length-of-stay were associated with more complications in the ACS-NSQIP group (p<0.01).

Conclusion: Patients at the HV center had lower rates of ACS-NSQIP-defined complications than those in the ACS-NSQIP database and had higher rates of completely laparoscopic procedures. This suggests that laparoscopic adrenalectomy may be underutilized nationally. In addition, ACS-NSQIP should consider including important determinants of outcome such as adrenalectomy-specific complications (e.g., adrenal insufficiency) and intraoperative blood loss.

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