title: Elective laparoscopic adrenalectomy outcomes in 1099 ACS NSQIP patients: identifying candidates for early discharge.
abstract: This study evaluates the risk of complications associated with elective laparoscopic adrenalectomy (LA) as reported in a national dataset. We hypothesize that the risk for major complication is associated with identifiable perioperative variables. This information may aid in understanding who safely could be discharged early after surgery, including same-day discharge. Elective LA from 2009 to 2010 American College of Surgeons National Surgical Quality Improvement Program Participant Use File were reviewed. A priori selection of likely risk factors for complications was assessed for their association with morbidity. Sequential bivariable logistic regression was used to measure the statistical significance of each risk factor's observed association with the occurrence of major morbidity after surgery. The potential for multiple comparisons bias was accounted for by using a high threshold (P < 0.01) for identifying statistically significant associations. One thousand ninety-nine patients were identified. The 30-day mortality rate was 0.18 per cent, and 4.8 per cent of patients experienced a major morbidity within 30 days of surgery. Return to the operating room occurred in 1.46 per cent of cases. Statistically significant associations occurred for 15 patient characteristics at P < 0.05. Diabetes, nonindependent functional status before surgery, American Society of Anesthesiologists classification >2, and operative time were statistically significant at P < 0.01. Complications are rare events among elective LA patients. However, several readily identifiable patient characteristics are associated with the occurrence of complications among these patients. These patient characteristics should be taken into account when considering future trials of early discharge after LA, including same-day discharge.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: John B
authors.initials: JB
authors.lastname: Hanks
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
mesh_terms: D000315:Adrenalectomy / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D018579:Patient Selection; D058996:Quality Improvement