title: Perioperative outcomes after adrenalectomy for malignant neoplasm in laparoscopic era:  a multicenter retrospective study.
abstract: BACKGROUND
  This study aims to review perioperative outcomes of adrenalectomy for malignant neoplasm performed by open or laparoscopic technique and comparing them with benign diseases.
  
  
  METHODS
  This study is a multicenter, retrospective analysis utilizing a large administrative database. The University Health System Consortium is an alliance of over 100 academic medical centers and 250 affiliate hospitals. The University Health System Consortium database was accessed using International Classification of Diseases codes.
  
  
  RESULTS
  A total of 6157 patients underwent adrenalectomy between January 2008 and June 2011. Of these, 5101 patients underwent open adrenalectomy (OA) and 1056 underwent adrenalectomy by laparoscopic technique (LA). Comparison between LA and OA showed lower morbidity (4.8% vs. 7.2%, P=0.0007), hospital length of stay (d) (3.23±5.66 vs. 4.35±6.59, P<0.0001), ICU admission rate (18.19% vs. 23.75%, P<0.0001), and cost ($) (9250±14306 vs. 11634±16547, P<0.0001) for LA, with no statistical difference in observed mortality or 30-day readmission rate. We then compared open and laparoscopic procedures performed for benign and malignant diagnoses.
  
  
  CONCLUSIONS
  Overall, LA had better outcomes than OA. When comparisons were made between LA and OA for benign adrenal diseases, all outcomes were significantly better in the laparoscopic group. There were, however, no statistical differences when LA was compared with OA for malignant diagnoses.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Shaligram
authors.forename: Jayaraj
authors.initials: J
authors.lastname: Unnirevi
authors.forename: Avishai
authors.initials: A
authors.lastname: Meyer
authors.forename: Jason F
authors.initials: JF
authors.lastname: Reynoso
authors.forename: Pradeep
authors.initials: P
authors.lastname: Pallati
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult