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Risk factors for intraoperative complications, postoperative complications, and prolonged length of stay after laparoscopic adrenalectomy by transperitoneal lateral approach: a retrospective cohort study of 547 procedures

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Abstract

Background

Laparoscopic adrenalectomy (LA) is the gold standard for the resection of most adrenal lesions. A precise delineation of factors influencing its outcomes is lacking. The aim of this study was to assess factors associated with intraoperative complications, postoperative complications, and prolonged length of stay (LOS) after LA.

Methods

Patients who underwent LA from 1999 to 2021 in a single-academic-institution were included. Patient and disease-specific data, intraoperative complications, postoperative complications according to Dindo–Clavien (DC) scale, and LOS were recorded. Predictive factors of complications and prolonged LOS were determined by logistic regression.

Results

We identified 530 patients who underwent 547 LA. Intraoperative complications occurred in 33 patients (6.0%). Postoperative complications ≥  DC grade 2 occurred in 73 patients (13.35%); severe postoperative complications ≥ DC grade 3 in 14 patients (2.56%). Postoperative complications were positively associated with age ≥ 72 (OR 1.14 [95% CI 1.02–1.29]), intraoperative complications (OR 1.36 [95% CI 1.14–1.63]), and negatively associated with non functional adenomas (OR 0.88 [95% CI 0.7–0.99]), and right adrenalectomy (OR 0.91 [95% CI 0.86–0.97]). Severe postoperative complications were positively associated with chronic obstructive pulmonary disease (COPD, OR 1.08 [95% CI 1.00–1.17]), and negatively associated with right adrenalectomy (OR 0.97 [95% CI 0.92–0.99]). Prolonged LOS was associated with age ≥ 72 (OR 1.21 [95% CI 1.05–1.41]), and COPD (OR 1.20 [95% CI 1.01–1.44]).

Conclusions

LA remains safe when performed by surgeons with expertise. Right adrenalectomy resulted in less postoperative overall and severe complications. The risk–benefit equation should be carefully assessed before left LA in older patients with COPD.

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This study received no funding.

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Authors and Affiliations

  1. Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France

    Donatien Fouche, Damien Bouriez, Caroline Gronnier, Denis Collet & Haythem Najah

  2. University of Bordeaux, INSERM, BPH U1219, F-33000, Bordeaux, France

    Gabrielle Chenais

  3. Endocrinology Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France

    Magalie Haissaguerre & Antoine Tabarin

  4. Department of Endocrine Surgery, Hôpital Haut Lévêque, University Hospital of Bordeaux, Avenue Magellan, 33604, Pessac, France

    Haythem Najah

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  1. Donatien Fouche
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Correspondence to Haythem Najah.

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The authors Donatien Fouche, Gabrielle Chenais, Magalie Haissaguerre, Damien Bouriez, Caroline Gronnier, Denis Collet, Antoine Tabarin and Haythem Najah have no conflicts of interest to disclose. This study received no funding.

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Fouche, D., Chenais, G., Haissaguerre, M. et al. Risk factors for intraoperative complications, postoperative complications, and prolonged length of stay after laparoscopic adrenalectomy by transperitoneal lateral approach: a retrospective cohort study of 547 procedures. Surg Endosc 37, 7573–7581 (2023). https://doi.org/10.1007/s00464-023-10148-0

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