Open Conversion at Robotic Adrenalectomy: Rates and Predictors.

BACKGROUND

Rates and predictors of open conversion at robotic adrenalectomy (rRA) are unknown.

METHODS

We identified patients treated with rRA (National Inpatient Sample 2009-2019). First, temporal trends in open conversion were assessed using Estimated Annual Percentage Changes (EAPC). Second, multivariable logistic regression models were used to identify predictors of open conversion during rRA.

RESULTS

Of 2,292 rRA patients, 286 (12.0%) underwent open conversion. The rates of open conversion decreased over time from 39.2% to 10.2% over the study span (EAPC -15.9%; p = 0.0003). Open conversion patients during rRA were more frequently male (59.0 vs. 53.0%; p = 0.04) and had more comorbidities (Charlson Comorbidity Index [CCI] ≥ 4: 28.0 vs. 17.0%; p < 0.001). In multivariable logistic regression models predicting open conversion, CCI ≥ 4 versus 0-3 (OR: 2.0; p < 0.001) and low versus medium-high surgical volume hospital (OR: 2.0; p < 0.001) were independent predictors. A dose-response effect was observed when CCI and hospital volume were combined. Specifically, the rates of open conversion were respectively 13.9 versus 25.9% in patient with CCI 0-3 versus CCI ≥ 4 at low surgical volume hospitals (p < 0.001). Conversely, the rates of open conversion were respectively 7.7 versus 13.4% in patient with CCI 0-3 versus CCI ≥ 4 at medium-high surgical volume hospitals (p < 0.001).

CONCLUSION

The rate of open conversion at rRA significantly decreased over time from 39.2% to 10.2%. Individuals at particularly elevated risk consisted of patients with CCI ≥ 4 in whom rRA is contemplated at low-volume hospitals (25.9%). Relegation of such individuals to medium-high surgical volume hospitals may reduce the conversion rate by half (13.4%).