Predictors of complication after adrenalectomy

Vol. 45 (3): 514-522, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0482


ORIGINAL ARTICLE

Victor Srougi 1, Joao A. B. Barbosa 1, Isaac Massaud 1, Isadora P. Cavalcante 2, Fabio Y. Tanno 1, Madson Q. Almeida 2, Miguel Srougi 1, Maria C. Fragoso 2, José L. Chambo 1
1 Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Purpose: To investigate risk factors for complications in patients undergoing adrenalectomy.

Materials and Methods: A retrospective search of our institutional database was performed of patients who underwent adrenalectomy, between 2014 and 2018. Clinical parameters and adrenal disorder characteristics were assessed and correlated to intra and post-operative course. Complications were analyzed within 30-days after surgery.

A logistic regression was performed in order to identify independent predictors of morbidity in patients after adrenalectomy.

Results: The fi les of 154 patients were reviewed. Median age and Body Mass Index (BMI) were 52-years and 27.8kg/m2, respectively. Mean tumor size was 4.9±4cm. Median surgery duration and estimated blood loss were 140min and 50mL, respectively.

There were six conversions to open surgery. Minor and major post-operative complications occurred in 17.5% and 8.4% of the patients. Intra-operative complications occurred in 26.6% of the patients. Four patients died. Mean hospitalization duration was 4-days (Interquartile Range: 3-8). Patients age (p=0.004), comorbidities (p=0.003) and pathological diagnosis (p=0.003) were independent predictors of post-operative complications. Tumor size (p<0.001) and BMI (p=0.009) were independent predictors of intra-operative complications. Pathological diagnosis (p<0.001) and Charlson score (p=0.013) were independent predictors of death.

Conclusion: Diligent care is needed with older patients, with multiple comorbidities and harboring unfavorable adrenal disorders (adrenocortical carcinoma and pheocromocytoma), who have greater risk of post-operative complications. Patients with elevated BMI and larger tumors have higher risk of intra, but not of post-operative complications.

Keywords: Adrenalectomy; Morbidity; Pathology

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