Defining the feasibility of same day adrenalectomy - A prospective matched cohort study

Gabriele Galata'; Katerina Alexandrou; Nadia Talat; Helena Hanschell; Ammar Al-Lawati; Patrick Klang; Assef Jawaada; Fraser Dunsire; Johnathan Hubbard; Dylan Lewis; Simon Aylwin; Klaus-Martin Schulte

doi:10.1016/j.sopen.2023.07.009

Defining the feasibility of same day adrenalectomy - A prospective matched cohort study

Surg Open Sci. 2023 Jul 20:14:75-80. doi: 10.1016/j.sopen.2023.07.009. eCollection 2023 Aug.

Authors

Affiliations

¹ Department of Endocrine and General Surgery, King's College Hospital NHS Foundation Trust, London, UK.
² Department of Anaesthesiology, King's College Hospital NHS, London, UK.
³ Department of Endocrine and General Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
⁴ Department of Radiology, King's College Hospital NHS, London, UK.
⁵ Department of Endocrinology, King's College Hospital NHS, London, UK.
⁶ Department of Surgery, Australian National University, Canberra, Australia.

Abstract

Background: Despite technical advances, day surgery still accounts for <1 % of adrenal procedures. We investigated feasibility and safety of same day adrenalectomy (SDA).

Methods: Between We recruited 30 patients with primary hyperaldosteronism (PHA) or Cushing's syndrome (CS) into a prospective matched, single centre cohort study to evaluate the impact of exposure to a same day discharge pathway (SDA cohort; n = 10) or inpatient adrenalectomy (PIPA cohort; n = 20). We compared results to a matched cohort (n = 40) from our prospective in-patient adrenalectomy registry (RIPA cohort).

Results: Mean age was 51.3 ± 8.5 years, with 43 % female, 3.3 % ASA I and 96.7 % ASA II. Lesion size was 17 ± 9 mm (range 5-40 mm). 80 % of patients presented with PHA. The predefined primary endpoint (discharge on same calendar day without major complications, emergency presentation or readmission) was achieved in 100 % of SDA, but none of the in-patients (χ² = 57; p < 0.0001). The secondary endpoint (discharge within 23 h of surgery without major complications, emergency presentation or readmission) was achieved in 100 % of SDA, 90 % of PIPA (n.s.), 33 % of RIPA (33 %; χ2 = 14.6 p < 0.001), and 51.5 % of IPA patients (χ2 = 8.5 p < 0.01). Combining SDA and PIPA cohorts, 93.3 % of treatment episodes met widely used (WHO, United States) definitions of day surgery as completion of the hospital care episode within 23 h. Patients admitted for SDA were highly satisfied (100 %).

Conclusion: Same day discharge after adrenalectomy is feasible, safe, and well-perceived in appropriately selected patients with PHA and Cushing's syndrome.

Keywords: Adrenalectomy; Ambulatory; Cushing's syndrome; Day case; Day surgery; Enhanced recovery; Keyhole; Laparoscopy; Outpatient; Primary hyperaldosteronism; Same day discharge.