Laparoscopic adrenalectomy for benign adrenal masses: An analysis of patients from the NIS database

Muhammad Asad Khan, MD, John N. Afthinos, MD, FACS, Karen E. Gibbs, MD, FACS

Staten Island University Hospital

Objective: Laparoscopic adrenalectomy (LA) is considered the gold standard for surgical treatment of benign adrenal masses, including those that demonstrate hormonal function. To date, most studies regarding such masses are case series from a single surgeon or a single institution due to their relative infrequency. We sought to compile a significant number of patients using a large, prospectively collected database to better characterize this patient population and the resultant outcomes of this approach.

Methods: The National Inpatient Sample Database was queried for patients discharged from the hospital for adrenalectomy for benign adrenal masses from 2005—2009. Malignant lesions, concomitant nephrectomy or pancreatectomy were excluded from the analysis. Patient comorbid conditions, age and gender were analyzed. Length of stay, in-hospital post-operative complications and mortality were evaluated. These were compared for LA and open adrenalectomy (OA).

Results: A total of 30,204 adrenalectomies were identified during the years 2005 through 2009. Of these, 24,288 were for benign disease. Only 4012 (16.5%) were performed laparoscopically. Unilateral adrenalectomy was performed in 3659 cases (91.2%) and bilateral in 100 cases (2.5%).

Table 1. Demographics and co-morbidities of patients

	Lap adernalectomy N=4012	Open adernalectomy N=20276	P
Female	2506 (62.9%)	12356 (61.3%)	0.11
Age	52.6 +/- 14.6	52.2 +/- 15.2	0.69
Hypertension	2601 (64.8%)	12216 (60.2%)	<.001
Hyperlipidemia	541 (13.5%)	2637(13%)	0.41
Smoking	558 (13.9%)	3020 (14.9%)	0.114
CAD	351 (8.7%)	1559 (7.9%)	0.059

Table 2: Postoperative complications, hospital course and mortality

	Lap adrenalectomy N=4012	Open adernalectomy N=20276	P
Pneumonia	50 (1.2%)	323 (1.6%)	0.109
Infection	19 (0.2%)	138 (0.7)	0.164
DVT	10 (0.2%)	58 (0.3%)	.870
Hemmorhage	36 (0.9%)	331 (1.6%)	< .001
Cardiac complications	40 (1.0%)	249 (1.2%)	0.234
Postop shock	10 (0.2%)	49 (0.2%)	0.862
Length of stay	3.4 +/- 5.3	4.5 +/-6.1	< .001
Mortality	24 (0.6%)	89 (0.4%)	0.115

Conclusions: Our investigation yielded a surprisingly low rate of laparoscopic adrenalectomy for benign adrenal disease. It is unclear if this is due to lesion size or surgeon experience.

Among LA there is an overall low, but significant, rate of post-operative pneumonia, hemorrhage and cardiac complications.

Compared to OA, LA has reduced morbidity and shorter hospital stay, especially when performed at teaching hospitals. This suggests that LA should be performed in these settings to effect the best outcomes.

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Session: Poster Presentation

Program Number: P559