Laparoscopic versus open adrenalectomy: Another look at outcome using the Clavien classification system

• Published in: Surgery Vol. 152; no. 6; pp. 1090 - 1095
• Main Authors: Eichhorn-Wharry, Laura I., MD, Talpos, Gary B., MD, Rubinfeld, Ilan, MD, MBA
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2012; Elsevier
• Subjects: Adrenalectomy - adverse effects; Adrenalectomy - methods; Biological and medical sciences; Female; General aspects; Humans; Intensive Care Units; Laparoscopy - adverse effects; Length of Stay; Male; Medical sciences; Middle Aged; Postoperative Complications; Surgery; Treatment Outcome; Medicine; Endoscopic surgery; Prognosis; Treatment; Classification; Evolution; Comparative study
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2012.08.020

Background A laparoscopic approach to adrenalectomy has become the procedure of choice for most adrenal resections. We hypothesized that laparoscopic adrenalectomy is less likely to result in intensive care unit (ICU) level complications or death than open adrenalectomy, despite baseline comorbidity mix. Methods Using the National Surgical Quality Improvement Program (NSQIP) participant use files for 2005–2009, all laparoscopic and open adrenalectomies were identified by current procedural terminology. Adverse outcomes tracked in NSQIP were mapped to Clavien level based on need for ICU care or death. Univariate and multivariate analysis were used to compare groups. Results There were 1,980 laparoscopic and 592 open procedures. Clavien 4 and 5 complications occurred in 45 (7.6%) of open and 35 (1.8%) of laparoscopic operations. The univariate odds ratio showed a 4.6-fold greater likelihood that a patient would have an ICU level complication ( P < .001), and 4.9 odds ratio of death ( P < .001) if an open rather than laparoscopic operation was performed. Regression modeling showed persistence of the protective effect of laparoscopy after adjusting for comorbidities with a multivariate odds ratio of 3.3 ( P < .001). Conclusion The laparoscopic approach to adrenalectomy has an independent protective effect on ICU level complications and mortality when compared with open procedures. This correlation persists after correcting for multiple comorbidities.