Trends of surgical treatment and enhanced recovery after surgery (ERAS) application for adrenal tumors: An 11-year observational study based on electronic medical record

Abstract

Background: Adrenal tumor is a common condition that often requires adrenalectomy. The objective of this study is to compare the safety and implementation of the enhanced recovery after surgery (ERAS) among patients who received open, laparoscopic and robotic-assisted operation. The impact of ERAS on health economics was also preliminarily evaluated.

Methods: This is a retrospective study using the electronic medical records of patients with adrenal tumor at the University of Hong Kong-Shenzhen Hospital between January 2013 and December 2023. All the patients received partial or total adrenalectomy via different surgical approaches.

Results: A total of 254 participants were included in our study. Among them, 229 (90.2%) received laparoscopic adrenalectomy, 12 (4.7%) received robotic-assisted operation, and 13 (5.1%) received open surgery. The majority of the patients' costs (n = 200, 78.7%) were covered by national health insurance in China. The proportion of robotic surgery increased significantly over time (p < 0.001). Laparoscopic surgery showed significantly shorter operating time and less bleeding than open surgery (p < 0.001). Implementation of ERAS after surgery increased from 3% in 2013-2015 to 46% in 2022-2023 following the 4N protocol (no drainage, no antibiotics, no opioid analgesia, and no intravenous fluids). The out-of-pocket expenses for patients decreased from CNY 11 700 in 2013 to CNY 2700 in 2023.

Conclusion: The proportion of ERAS has increased. Despite increased total expenses, the out-of-pocket expenses for patients have significantly decreased over time via implementation of the ERAS approach.

Keywords

adrenal / complication / enhanced recovery after surgery / health economics / laparoscopic / robotic / surgery

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