Presented by: Celeste Manfredi
Rush university medical center

Introduction

Despite widespread use of robotic assisted surgery over the past 2 decades, nationwide data on the contemporary utilization and outcomes of robotic-assisted adrenal surgery are lacking.  We investigated nationwide trends in the utilization of robotic-assisted adrenalectomy for adrenal masses, and analyzed postoperative complications as well as impact of social determinants of health (SDOH) on postoperative complications.

Materials

Patients who underwent open vs. robotic/lap adrenalectomy between 2011 and 2021 were retrospectively analyzed using PearlDiver-Mariner, a nationwide all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes were used to identify the type of surgical operation, patient’s characteristics, postoperative complications and presence of SDOH. Trends in utilization were analyzed using Mann-Kendall test. Determinants of postoperative complications were analyzed using multivariable regression models.

Results

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Overall, 11,477 patients underwent open (n= 3,751) and robotic/lap (n= 7,726) adrenalectomy. The overall numbers of open adrenalectomies significantly decreased from 2011 to 2021 (p = 0.05), while number of robotic adrenalectomies remained nearly stable over time (p > 0.05). Open adrenalectomies were primarily performed for adenoma (73%) vs carcinoma (26%) vs pheocromocytoma 1%), compared with 90% vs 9% vs 1% respectively for robotic adrenalectomy. The 60-day postoperative complication rate was 16% for open vs. 10% for robotic adrenalectomy (p < 0.05). Presence of SDOH were identified in 949 patients (8 %); 172 (4%) for patients undergoing open vs 777 (10%) for those undergoing robotic surgery. SDOH were associated with significantly higher odds of postoperative complications (Open= OR:1.58, 95% CI:0.95-2.54; Robot/Lap = OR:1.41, 95% CI:1.06-1.84).

Conclusion

Minimally invasive adrenalectomy is utilized for 67% of adrenal masses in the contemporary era, but open surgery plays a bigger role for adrenocortical carcinoma. SDOH are associated with a higher risk of postoperative complications regardless of the surgical technique utilized.

Funding

None

Co-Authors

Antonio Franco,
Rush university medical center

Morgan R. Sturgis,
Rush university medical center

Francesco Ditonno,
Rush university medical center

Jamie Yoon,
Rush university medical center

Daniel Roadman,
Rush university medical center

Adan Z Becerra,
Rush university medical center

Srinivas Vourganti,
Rush university medical center

Riccardo Autorino,
Rush university medical center

Ephrem O Olweny,
Rush university medical center