Factors associated with prolonged hospital stay after laparoscopic adrenalectomy
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ORIGINAL ARTICLE
Factors associated with prolonged hospital stay after laparoscopic adrenalectomy José Ignacio Rodríguez‑Hermosa1 · Olga Delisau2 · Pere Planellas‑Giné2 · Lídia Cornejo2 · Alejandro Ranea1 · Eloy Maldonado2 · José Manuel Fernández‑Real3 · Antoni Codina‑Cazador2 Received: 12 June 2020 / Accepted: 1 September 2020 © Italian Society of Surgery (SIC) 2020
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 2 days group (37.5% vs. 16.3%, p = 0.011). Compared to patients in the LOS ≤ 2 days group, a greater proportion of patients in the LOS > 2 days group had ASA score III or IV (71.9% vs. 52.3%, p = 0.016), were operated on in the period considered part of the learning curve (28.1% vs. 13.9%, p = 0.032), underwent surgery on Thursday or Friday (65.6% vs. 36%, p 2 days group. Functional tumors were
Fig. 1 Length of hospital stay in lateral transperitoneal laparoscopic adrenalectomy
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Updates in Surgery
Table 1 Patients undergoing lateral transperitoneal laparoscopic adrenalectomy Variable
LOS ≤ 2 days group n = 86
LOS > 2 days group n = 64
Total N = 150
Male Female Age, in years ASA I or II ASA III or IV BMI (kg/m2) Obesity Prior abdominal surgery Right adrenal tumor Left adrenal tumor Learning curve Monday through Wednesday Thursday through Friday 2D laparoscopy 3D laparoscopy Operative time, in min Operative time, in min 5 days) after LTLA, Pisarska et al. [11] found that prolonged LOS (> 2 days) was associated with postoperative complications,
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pheochromocytoma, need for drainage, and day of the week of surgery (Thursday or Friday). Increasing patient age (> 60 years) is a predictor for postoperative complications after LA, and older patients are more likely to have prolonged LOS [9, 20, 21]. In our series, 43 (28.7%) patients were aged > 60 years; in this subgroup, 1 (2.3%) patient had a complication (acute urine retention in a patient with prostate syndrome), 1 (2.3%) required conversion (for 200 mL blood loss), and the median of LOS was 2 days (range, 1–4 days). Higher ASA score is significantly associated with postoperative complications a
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