Helena Hanschell1, Gabriele Galata1, Katerina Alexandrou1, Nadia Talat1, Ammar Al-Lawati1, Patrick Klang1, Assef Jawaada1, Fraser Dunsire1, Johnathan Hubbard1,2, Dylan Lewis1, Simon Aylwin1, Klaus-Martin Schulte1,3
1King's College Hospital, London, United Kingdom. 2Guy's and St. Thomas' Hospital, London, United Kingdom. 3Australian National University, Canberra, Australia
Abstract
Introduction: Same-day discharge is becoming increasingly popular across a number of surgical specialities, however, less than 1% of adrenal surgeries are performed as day cases. Our study aimed to investigate whether same day adrenalectomy (SDA) was safe, feasible and economical.
Methods: 30 patients with primary hyperaldosteronism (PHA) or Cushing’s syndrome (CS) were prospectively matched at our centre between 01 September 2021 and 28 February 2023. We assessed the effect of a same day discharge pathway (SDA cohort; n=10) and inpatient adrenalectomy pathway (PIPA cohort; n=20) on predefined composite outcomes. Results were validated by matching the cohorts with our retrospective in-patient adrenalectomy registry (RIPA cohort; n=40). All inpatients were merged to create an IPA cohort (RIPA + PIPA).
Results: The study cohort was aged 51.3±8.5 years, with 43% of the cohort being female and 96.7% ASA II. Lesion size was 17±9mm (range 5-40mm), 56.7% on the left side and 80% of the patients had PHA. No differences for outcome predictors or modifiers were identified between cohorts. Patients discharged on the same day with no complications or readmission was achieved in 100% of SDA. 90% of PIPA, 33% of RIPA and 51.5% of IPA were discharged within 23 hours with no complications or readmission. Costs were significantly lower for the SDA cohort and patient satisfaction was 100%.
Conclusion: Our study provides novel evidence that same day discharge after adrenalectomy in patients with PHA and CS is not only feasible and safe, but is also economical and well-received.