Department of Surgery, Creighton University, Omaha, NE, 68131, USA.
Surg Endosc. 2011 Mar;25(3):784-94. doi: 10.1007/s00464-010-1256-y. Epub 2010 Aug 18.
Laparoscopic adrenalectomy (LA) has become the standard of care for many conditions requiring removal of the adrenal gland. Previous studies on outcomes after LA have had limitations. This report describes the 30-day morbidity and mortality rates after LA and analyzes factors affecting operative time, hospital length of stay (LOS), and postoperative morbidity.
Patients undergoing LA in 2007 and 2008 were identified from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). Using multivariate analysis of variance (ANOVA) and logistic regression, 52 demographic/comorbidity variables were analyzed to ascertain factors affecting operative time, LOS, and morbidity.
The mean age of the 988 patients was 53.5 ± 13.7 years, and 60% of the patients were women. The mean body mass index (BMI) of the patients was 31.8 ± 7.9 kg/m(2). The 30-day morbidity and mortality rates were 6.8% and 0.5%, respectively. The mean and median operative times were 146.7 ± 66.8 min and 134 min, respectively. The mean and median hospital stays were 2.6 ± 3.1 days and 2 days, respectively. Compared with independent status, totally dependent functional status was associated with a 9.5-day increase in LOS (P = 0.0006) and an increased risk for postoperative morbidity (odds ratio [OR], 14.7; 95% confidence interval [CI], 2.4-91.9; P < 0.0001). Peripheral vascular disease (OR, 7.3; 95% CI, 1.7-31.7; P = 0.008) also was associated with increased 30-day morbidity. Neurologic and respiratory comorbidities were associated with increased LOS (P < 0.05). American Society of Anesthesiology (ASA) class 4 patients had a longer operative time than ASA class 1 patients (P = 0.002).
The morbidity and mortality rates after LA are low. Dependent functional status and peripheral vascular disease predispose to postoperative morbidity. Dependent status, higher ASA class, and respiratory and neurologic comorbidities are associated with longer operative time and LOS.
腹腔镜肾上腺切除术（LA）已成为许多需要切除肾上腺的疾病的标准治疗方法。之前关于 LA 后结果的研究存在局限性。本报告描述了 LA 后 30 天的发病率和死亡率，并分析了影响手术时间、住院时间（LOS）和术后发病率的因素。
从美国外科医师学会国家手术质量改进计划（NSQIP）中确定了 2007 年和 2008 年接受 LA 的患者。使用方差分析（ANOVA）和 logistic 回归的多变量分析，分析了 52 个人口统计学/合并症变量，以确定影响手术时间、LOS 和发病率的因素。
988 例患者的平均年龄为 53.5 ± 13.7 岁，其中 60%为女性。患者的平均体重指数（BMI）为 31.8 ± 7.9 kg/m2。30 天发病率和死亡率分别为 6.8%和 0.5%。平均和中位数手术时间分别为 146.7 ± 66.8 分钟和 134 分钟。平均和中位数住院时间分别为 2.6 ± 3.1 天和 2 天。与独立状态相比，完全依赖的功能状态与 LOS 增加 9.5 天（P = 0.0006）和术后发病率增加相关（优势比[OR]，14.7；95%置信区间[CI]，2.4-91.9；P < 0.0001）。周围血管疾病（OR，7.3；95%CI，1.7-31.7；P = 0.008）也与 30 天发病率增加相关。神经和呼吸合并症与 LOS 延长相关（P < 0.05）。美国麻醉医师学会（ASA）分级 4 级患者的手术时间长于 ASA 分级 1 级患者（P = 0.002）。
LA 后的发病率和死亡率较低。依赖的功能状态和周围血管疾病易导致术后发病率增加。依赖状态、较高的 ASA 分级以及呼吸和神经合并症与较长的手术时间和 LOS 相关。
