National trends in ambulatory and inpatient minimally invasive adrenalectomy in the United States.

Abstract

The use of minimally invasive adrenalectomy has expanded. Although ambulatory minimally invasive adrenalectomy has demonstrated safety and feasibility in select settings, trends in utilization, surgical indication, and outcomes remain limited. This study aimed to evaluate national trends in the adoption and incidence of inpatient and ambulatory minimally invasive adrenalectomy in the United States from 2016 to 2022. We conducted a retrospective cross-sectional study using the Nationwide Ambulatory Surgery Sample and National Inpatient Sample to identify adults aged ≥20 years who underwent elective minimally invasive adrenalectomy. Surgical indication, laterality, patient demographics, and hospital characteristics were assessed. Outcomes included charge, discharge disposition, and mortality. Age- and sex-adjusted incidence was reported per 100,000 adults. Among a weighted total of 35,242 minimally invasive adrenalectomies, 8,917 (25.3%) were ambulatory. Ambulatory incidence rose from 0.22 to 0.59 per 100,000 adults (incidence rate ratio: 2.75, 95% confidence interval: 2.34-3.24), whereas inpatient incidence increased at a lower rate (incidence rate ratio: 1.24, 95% confidence interval: 1.07-1.43). Benign adrenal neoplasm was the most common indication in both settings. Ambulatory incidence increased for all indications except primary malignant neoplasms. Both left- and right-sided ambulatory adrenalectomies increased, with left-sided procedures being more common. Charges were lower in ambulatory settings. Overall, non-home discharge and mortality were rare. Incidence of ambulatory adrenalectomy has nearly tripled in less than a decade, primarily driven by benign adrenal neoplasms and outpacing increases in inpatient adrenalectomy. Given the substantial rise, societal guidelines and further evaluation of adrenalectomy-specific outcomes are needed to identify patients who may benefit from ambulatory adrenalectomy.