Factors associated with prolonged hospital stay after laparoscopic adrenalectomy

Abstract

Laparoscopy is the standard technique for resecting adrenal tumors, but short-term outcomes such as length of stay (LOS) vary widely between centers. We aimed to identify factors associated with LOS after lateral transperitoneal laparoscopic adrenalectomy (LTLA). We analyzed consecutive patients undergoing unilateral LTLA between April 2003 and April 2020. Prolonged LOS was defined as a stay longer than the 75th percentile of the overall cohort. To identify potential factors associated with prolonged LOS, we compared collected data from patients with LOS ≤ 2 days versus LOS > 2 days and elaborated multivariate logistic regression models. We included 150 patients (73 men and 77 women, median age 54 years), with benign (n = 128) and malignant tumors (n = 22). The median LOS after LTLA was 2 days; 64 (42.7%) patients had prolonged hospitalization. Variables significantly associated with prolonged LOS in the univariate analysis included ASA III + IV (p = 0.016), pheochromocytoma (p < 0.001), learning curve (p = 0.032), surgery on Thursday or Friday (p < 0.001), 2D laparoscopy (p = 0.003), operative time (p < 0.001), estimated blood loss (p < 0.001), drainage (p < 0.001), specimen size (p = 0.011), conversions (p = 0.002), complications (p = 0.019), and hospital stay (p < 0.001). After adjustment for patient, surgical, and tumor characteristics, risk factors associated with prolonged LOS in the multivariate analysis were specimen size > 9 cm (OR:13.03, p = 0.005), surgery on Thursday or Friday (OR:6.92, p = 0.001), estimated blood loss ≥ 60 ml (OR:6.22, p = 0.021), and drainage (OR:5.29, p = 0.005). Prolonged length of stay after LTLA was associated with specimen size > 9 cm, operating on Thursday or Friday, estimated blood loss ≥ 60 mL, and drainage.

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Study conception and design: JIR-H, OD, PP-G, JMF-R and AC-C. Literature review: JIR-H, OD, PP-G, LC, AR, EM, JMF-R, and AC-C. Acquisition of data: JIR-H, OD, LC, and AR. Analysis and interpretation of data: JIR-H, OD, PP-G, LC, AR, EM, JMF-R, and AC-C. Drafting of the manuscript: JIR-H, OD, PP-G, LC and AC-C. Critical revision and final approval of the manuscript: JIR-H, OD, PP-G, LC, AR, EM, JMF-R, and AC-C. All agree to be held accountable for all aspects of the work.

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Correspondence to José Ignacio Rodríguez-Hermosa.

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Rodríguez-Hermosa, J.I., Delisau, O., Planellas-Giné, P. et al. Factors associated with prolonged hospital stay after laparoscopic adrenalectomy. Updates Surg (2020). https://doi.org/10.1007/s13304-020-00880-w

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Keywords

  • Adrenal tumors
  • Hospital stay
  • Laparoscopic adrenalectomy
  • Lateral transperitoneal laparoscopic approach
  • Minimally invasive surgery