J. Limberg2, K. D. Gray1,2, T. Ullmann1,2, D. Stefanova1,2, B. M. Finnerty1,2, J. L. Buicko1,2, R. Zarnegar1,2, T. J. Fahey1,2, T. Beninato1,2 1New York Presbyterian Hospital,Surgery,New York, NY, USA 2Weill Cornell Medical College,Surgery,New York, NY, USA
Introduction:
Laparoscopic adrenalectomy (LA) is regarded as the treatment of choice for small, functioning tumors of the adrenal cortex. Despite evidence that surgical cure of primary hyperaldosteronism is superior to medical treatment, there remains reluctance to refer patients for LA, with some recent reports advocating long-term medical management. Here we aimed to determine whether the safety profile of LA is similar to that of elective laparoscopic cholecystectomy (LC), one of the most commonly performed laparoscopic procedures worldwide.
Methods:
Patients undergoing LA or LC between 2012 and 2015 were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients who had a LA for an adrenal adenoma or aldosteronoma were compared to those who had LC for biliary colic. Propensity scores with nearest neighbor matching were calculated to determine propensity of receiving LA controlling for age, gender, race, Hispanic ethnicity, American Society of Anesthesiologists score (ASA) and 5-Factor Modified Frailty Index Score. The 30-day readmission rate, incidence of any post-operative complication, as well as the incidence of specific complications such as myocardial infarction, stroke, sepsis, surgical site infection, pneumonia, unplanned reintubation, renal failure, urinary tract infection, clostridium difficile infection and pulmonary embolism were compared between groups.
Results:
A total of 83,928 patients underwent either LA or LC during the study period. There were 16,480 patients who met the inclusion criteria and were successfully matched (n=1,490 LA, n=14,990 LC). The overall mortality rate was 0.02%, with no difference between groups (p=0.084). After propensity matching, the mean age of patients undergoing LA was 47.5 years compared with 50.5 years in the LC group, and they contained 80.9% and 76.9% female patients, respectively. More LC patients were Hispanic (15.7% versus 12.9% LA). Patients in both groups had a similar rate of ASA score >3 (25.8% LA versus 24.7% LC) and Frailty Index Score >2 (7.0% LA versus 9.5% LC). There was no difference in the incidence of any post-operative complication between the two groups. The incidence of myocardial infarction (p=0.026) and wound infection (p<0.001 and p=0.002 for superficial and deep, respectively) were increased with LC. There were no statistically significant differences for the other specific post-operative complications between the two matched groups.
Conclusion:
In a propensity-matched comparison of patients from the ACS-NSQIP database undergoing LA and LC, there were no differences in the rate of overall postoperative complications and a slightly increased rate of wound complications and MI in patients undergoing LC. Physicians should consider LA to have an equivalent risk profile to LC when deciding whether to refer patients to surgery.