Laparoscopic versus robotic adrenalectomy

a review of the national inpatient sample

Sarah Samreen, Marcus Fluck, Marie Hunsinger, Jeffrey Wild, Mohsen Shabahang, Joseph A. Blansfield

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions. Recently, robotic-assisted adrenalectomy (RA) has become an option, however, short-term outcomes for RA have not been well studied and benefits over LA are debatable. The aim of this study was to explore differences in short-term outcomes between LA and RA using the national inpatient sample (NIS) database. Methods: Patient data were collected from the NIS. All patients undergoing LA or RA from January 2009 to December 2012 were included. Univariate analysis and propensity matching were performed to look for differences between the groups. Results: A total of 1006 patients (66.4% in LA group and 33.6% in RA group) were identified. Patient age group, gender, race, risk of mortality, severity of illness or indication for adrenalectomy did not differ significantly between the LA or RA cohorts. Insurance type predicted procedure type (45% of medicare patients underwent RA versus 29% of patients with private insurance, p < 0.0001). Patients living in the highest income areas were more likely to receive the laparoscopic approach (31.7 versus 17.4%, p < 0.0001). Hospital volume, bed size and teaching status of the hospital were not significant factors in the decision of RA versus LA. There was no difference in complication and conversion rates between RA versus LA. The mean length of stay was shorter in the RA group (2.2 versus 1.9 days, p = 0.03). Total charges were higher in the RA group ($42,659 versus $33,748, p < 0.0001). There was a significant trend towards more adrenalectomies being performed robotic assisted by year. Only 22% of adrenalectomies were performed robotic-assisted in 2009 compared with 48% in 2012. Conclusions: The overall benefit for RA remains small and higher total charges for RA may currently outweigh the benefits. These findings may change as more cases are performed robotically assisted and robotic technology improves.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalJournal of Robotic Surgery
Volume13
Issue number1
DOIs
StatePublished - Feb 11 2019
Externally publishedYes

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Adrenalectomy
Robotics
Inpatients
Insurance
Hospital Bed Capacity

Keywords

  • Adrenalectomy
  • Endocrine surgery
  • Laparoscopic surgery
  • National inpatient sample
  • Robotic surgery

ASJC Scopus subject areas

  • Surgery
  • Health Informatics

Cite this

Laparoscopic versus robotic adrenalectomy : a review of the national inpatient sample. / Samreen, Sarah; Fluck, Marcus; Hunsinger, Marie; Wild, Jeffrey; Shabahang, Mohsen; Blansfield, Joseph A.

In: Journal of Robotic Surgery, Vol. 13, No. 1, 11.02.2019, p. 69-75.

Research output: Contribution to journalArticle

Samreen, Sarah ; Fluck, Marcus ; Hunsinger, Marie ; Wild, Jeffrey ; Shabahang, Mohsen ; Blansfield, Joseph A. / Laparoscopic versus robotic adrenalectomy : a review of the national inpatient sample. In: Journal of Robotic Surgery. 2019 ; Vol. 13, No. 1. pp. 69-75.
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abstract = "Background: Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions. Recently, robotic-assisted adrenalectomy (RA) has become an option, however, short-term outcomes for RA have not been well studied and benefits over LA are debatable. The aim of this study was to explore differences in short-term outcomes between LA and RA using the national inpatient sample (NIS) database. Methods: Patient data were collected from the NIS. All patients undergoing LA or RA from January 2009 to December 2012 were included. Univariate analysis and propensity matching were performed to look for differences between the groups. Results: A total of 1006 patients (66.4{\%} in LA group and 33.6{\%} in RA group) were identified. Patient age group, gender, race, risk of mortality, severity of illness or indication for adrenalectomy did not differ significantly between the LA or RA cohorts. Insurance type predicted procedure type (45{\%} of medicare patients underwent RA versus 29{\%} of patients with private insurance, p < 0.0001). Patients living in the highest income areas were more likely to receive the laparoscopic approach (31.7 versus 17.4{\%}, p < 0.0001). Hospital volume, bed size and teaching status of the hospital were not significant factors in the decision of RA versus LA. There was no difference in complication and conversion rates between RA versus LA. The mean length of stay was shorter in the RA group (2.2 versus 1.9 days, p = 0.03). Total charges were higher in the RA group ($42,659 versus $33,748, p < 0.0001). There was a significant trend towards more adrenalectomies being performed robotic assisted by year. Only 22{\%} of adrenalectomies were performed robotic-assisted in 2009 compared with 48{\%} in 2012. Conclusions: The overall benefit for RA remains small and higher total charges for RA may currently outweigh the benefits. These findings may change as more cases are performed robotically assisted and robotic technology improves.",
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AU - Samreen, Sarah

AU - Fluck, Marcus

AU - Hunsinger, Marie

AU - Wild, Jeffrey

AU - Shabahang, Mohsen

AU - Blansfield, Joseph A.

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AB - Background: Laparoscopic adrenalectomy (LA) has become the standard treatment of adrenal lesions. Recently, robotic-assisted adrenalectomy (RA) has become an option, however, short-term outcomes for RA have not been well studied and benefits over LA are debatable. The aim of this study was to explore differences in short-term outcomes between LA and RA using the national inpatient sample (NIS) database. Methods: Patient data were collected from the NIS. All patients undergoing LA or RA from January 2009 to December 2012 were included. Univariate analysis and propensity matching were performed to look for differences between the groups. Results: A total of 1006 patients (66.4% in LA group and 33.6% in RA group) were identified. Patient age group, gender, race, risk of mortality, severity of illness or indication for adrenalectomy did not differ significantly between the LA or RA cohorts. Insurance type predicted procedure type (45% of medicare patients underwent RA versus 29% of patients with private insurance, p < 0.0001). Patients living in the highest income areas were more likely to receive the laparoscopic approach (31.7 versus 17.4%, p < 0.0001). Hospital volume, bed size and teaching status of the hospital were not significant factors in the decision of RA versus LA. There was no difference in complication and conversion rates between RA versus LA. The mean length of stay was shorter in the RA group (2.2 versus 1.9 days, p = 0.03). Total charges were higher in the RA group ($42,659 versus $33,748, p < 0.0001). There was a significant trend towards more adrenalectomies being performed robotic assisted by year. Only 22% of adrenalectomies were performed robotic-assisted in 2009 compared with 48% in 2012. Conclusions: The overall benefit for RA remains small and higher total charges for RA may currently outweigh the benefits. These findings may change as more cases are performed robotically assisted and robotic technology improves.

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KW - Endocrine surgery

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