Eighty patients (45 women and 35 men) underwent laparoscopic adrenalectomy between January 2000 and February 2010. Patients undergoing adrenalectomy as part of a larger operation were excluded. The majority of operations (70, 88%) were performed via a lateral transperitoneal approach, 10 (12%) patients underwent robotic adrenalectomy, and 2 patients had bilateral adrenalectomies performed via a lateral transperitoneal approach.
summarizes patient demographics. The mean age of the patient population was 52 years old. The mean diameter of adrenal glands resected was 4.5cm, with a higher proportion of masses resected were left sided (46 versus 32 lesions, 57.5% versus 40% with 2 patients having bilateral tumors). The largest percentage of these lesions were adenomas (39 out of 80, 49%), and no adrenocortical cancers were resected laparoscopically. Median operative time for our patient population was 124.5 minutes (range, 76 to 330), while median estimated blood loss (EBL) was 50mL (range, 5 to 1200). The median length of stay (LOS) was 1 day (range 1 to 14).
Forty-nine patients (61%) were obese by study criteria, with the mean BMI for our patients being 33.4kg/m2. compares the 2 cohorts of patients. Patient characteristics for the 2 groups are well matched. There was a trend towards older patients, patients who used tobacco, and patients with cardiac disease in the healthy weight group, but operative time, EBL and LOS did not differ significantly between the 2 cohorts.
Patient Characteristics by Obesity Status (n=80)
There was no 30-day mortality in the population. For classification, complications were divided into intraoperative and postoperative. Postoperative complications were further classified as major (pneumonia, deep wound infection, abdominal hematoma or abscess, DVT or PE) and minor (ileus, anemia not requiring blood transfusion, UTI, superficial wound infection).
As shown in , there were 9 significant complications in the obese population and no similar complications in the healthy weight population (P<.011). Four obese patients had intraoperative complications including 2 splenic lacerations, 1 pneumothorax, and 1 vein injury. Injuries occurred equally on the right and the left side. Five obese patients had significant postoperative morbidity, including 3 infectious complications, an intraabdominal hematoma, and a deep vein thrombosis. There was one conversion to open adrenalectomy that occurred in an obese patient due to bleeding from a splenic injury, eventually requiring splenectomy.
Complications After Laparoscopic Adrenalectomy
An unadjusted logistic regression model predicting all postoperative 30-day complications (n=24, 30%) was fit with the obesity status. The unadjusted odds ratio for obese compared to healthy weight is 2.42 (95% CI = 0.84, 7.01, P=.098, same as the Fisher's exact test, ). A multivariate logistic regression model was fit with possible covariates of sex, age, tobacco use, diabetes indicator, and history of cardiac disease. Using a step-wise model selection technique, the final multivariate logistic regression model for 30-day complication included obesity and sex as predictors. Adjusting for sex, the final logistic regression model predicting 30-day complications found obese patients were significantly (P=.038) more likely to have complications compared to healthy weight patients (O=3.41, 95% CI=1.07, 10.82). Males were significantly (P=.012) more likely to have 30-day complications (OR=3.96, 95% CI=1.36, 11.55). The final regression model for LOS had no significant predictors. Since skewed, LOS was also modeled as a log-transformed variable with no significant predictors. Obesity status was not significant in predicting minor postoperative complications (n=9, 11%).