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

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...

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Bibliographic Details
Published in:Surgery 2012-12, Vol.152 (6), p.1090-1095
Main Authors: Eichhorn-Wharry, Laura I., MD, Talpos, Gary B., MD, Rubinfeld, Ilan, MD, MBA
Format: Article
Language:English
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
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Summary: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.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2012.08.020