Risk factors for 30-day readmission after adrenalectomy

Abstract

Background: Readmissions represent a substantial burden to the health care system. Risk factors for 30-day readmission after adrenalectomy were examined.

Methods: Patients who underwent adrenalectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2015.

Results: Among 4,221 patients who underwent adrenalectomy, 216 (5.1%) were readmitted. On multivariate analysis, pre-operative predictive factors associated with readmission were American Society of Anesthesiologists classification (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.8), disseminated cancer (OR 1.6, CI 1.1-2.5), and adrenal injury (OR 10.9, CI 1.8-68.9). Elective procedures had fewer readmissions (OR 0.50, CI 0.33-0.76). and procedures with greater relative value units had greater readmission rates (OR 1.01, CI 1.004-1.02). An open adrenalectomy (21% of patients) had a higher rate of readmission than a laparoscopic approach (8.0% vs 4.3%, OR 1.5, CI 1.1-2.0). Postoperative risk factors affecting readmission included reoperations (OR 3.2, CI 1.3-8.0), wound complications (OR 6.6, CI 3.8-11.7), systemic infection (OR 6.5, CI 3.9-10.7), renal complications (OR 7.1, CI 2.6-19.2), venous thrombotic events (OR 11.3, CI 5.6-22.6), and discharge to home (OR 0.40, CI 0.22-0.73).

Conclusion: Encouraging the appropriate use of laparoscopic adrenalectomy, preventing venous thrombotic events and surgical infections, and improving early post-operative follow-up in high-risk patients may decrease readmissions.

Figure 1.. Rate of Adrenalectomy by Year.

Adrenalectomies reported in the NSQIP database over the study period increased from 633 (15%) procedures in 2011, 819 (19.4%) in 2012, 812 (19.2%) in 2013, 921 (21.8%) in 2014, and 1036 (24.5%) in 2015, (p=0.06). Additionally, there was a trend for a decrease in the number of adrenalectomies performed per institution (p=0.06).