S S Rayan1, R A Hodin. 1. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
Abstract
BACKGROUND: We performed a consecutive series of unilateral laparoscopic adrenalectomies (LA) with the expectation of short (less than 24 h) hospital stay. Results were compared with those from laparoscopic cholecystectomy (LC) and unilateral open adrenalectomy (OA). METHODS: A combination of chart review and patient questionnaires was used to compare LA (n = 19) to LC (n = 20) regarding length of stay (LOS), narcotic requirements, and time to full recovery. Chart reviews also were used to compare LA to OA (n = 48) regarding operating room time (OR time), LOS, and surgical morbidity. RESULTS: All of the LC patients as compared with 47% of the LA patients were discharged within 24 h. The reason for additional hospitalization in the LA group was pain control. After discharge, the narcotic requirement lasted 6.6 days in the LA group as compared with 3.4 days in the LC group (p < 0.01), but the times until full recovery were not significantly different (12.2 vs 11.3 days respectively). Operating room times did not differ significantly between the LA and OA groups (3.3 and 3.8 h, respectively), but there were fewer postoperative complications and much shorter LOS in the LA group (1.5 vs 6.3 days; p < 0.001), a difference that remained significant even when cases from the same time period were compared. CONCLUSIONS: Increased pain in LA as compared with LC patients may result in a slightly longer LOS and higher narcotic requirement during the early postoperative period, but time to full recovery between the two groups is the same. As compared with its open counterpart, LA offers a significant reduction in LOS and morbidity with no increase in OR time.
BACKGROUND: We performed a consecutive series of unilateral laparoscopic adrenalectomies (LA) with the expectation of short (less than 24 h) hospital stay. Results were compared with those from laparoscopic cholecystectomy (LC) and unilateral open adrenalectomy (OA). METHODS: A combination of chart review and patient questionnaires was used to compare LA (n = 19) to LC (n = 20) regarding length of stay (LOS), narcotic requirements, and time to full recovery. Chart reviews also were used to compare LA to OA (n = 48) regarding operating room time (OR time), LOS, and surgical morbidity. RESULTS: All of the LC patients as compared with 47% of the LA patients were discharged within 24 h. The reason for additional hospitalization in the LA group was pain control. After discharge, the narcotic requirement lasted 6.6 days in the LA group as compared with 3.4 days in the LC group (p < 0.01), but the times until full recovery were not significantly different (12.2 vs 11.3 days respectively). Operating room times did not differ significantly between the LA and OA groups (3.3 and 3.8 h, respectively), but there were fewer postoperative complications and much shorter LOS in the LA group (1.5 vs 6.3 days; p < 0.001), a difference that remained significant even when cases from the same time period were compared. CONCLUSIONS: Increased pain in LA as compared with LC patients may result in a slightly longer LOS and higher narcotic requirement during the early postoperative period, but time to full recovery between the two groups is the same. As compared with its open counterpart, LA offers a significant reduction in LOS and morbidity with no increase in OR time.
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