Importance Laparoscopic adrenalectomy is the gold standard for most adrenal disorders and its frequency in the United States is increasing. While national and administrative databases can adjust for patient factors, comorbidities, and institutional variations, granular disease-specific data that may significantly influence the incidence of perioperative complications and length of stay (LOS) are lacking.

Objective To investigate factors associated with perioperative complications and LOS after laparoscopic adrenalectomy.

Design, Setting, and Participants This cohort study was carried out at a single academic medical center, with all patients who underwent laparoscopic adrenalectomy between 1993 and 2017 by the endocrine surgery department. Multivariable linear and logistic regression were used to obtain adjusted odds ratios (ORs).

Main Outcomes and Measures The primary outcome was perioperative complications with a Dindo-Clavien grade of 2 or more. The secondary outcome was prolonged length of stay, defined as a stay longer than the 75th percentile of the overall cohort.

Results We identified 640 patients who underwent 653 laparoscopic adrenalectomies, of whom 370 (56.7%) were female. The median age was 51 (range, 5-88) years. A total of 76 complications with a Dindo-Clavien grade of 2 or more occurred in 55 patients (8.4%), with postoperative mortality in 2 patients (0.3%). The median hospital length of stay was 1 day (range, 0-32 days). Factors independently associated with increased complications were American Society of Anesthesiologists class 3 or 4 (OR, 2.78 [95% CI, 1.39-5.55]; P < .01), diabetes (OR, 2.39 [95% CI, 1.14-5.01]; P = .02), conversion to hand-assisted or open surgery (OR, 5.32 [95% CI, 1.84-15.41]; P < .01), a diagnosis of pheochromocytoma (OR, 4.31 [95% CI, 1.43-13.05]; P = .01), and a tumor size of 6 cm or greater (OR, 2.47 [95% CI, 1.05-5.78]; P = .04). Prolonged length of stay was associated with age 65 years or older (OR, 2.44 [95% CI, 1.31-4.57]; P = .01), an American Society of Anesthesiologists class 3 or 4 (OR, 3.48 [95% CI, 1.88-6.41]; P < .01), any procedural conversion (OR, 63.28 [95% CI, 12.53-319.59]; P < .01), and a tumor size of 4 cm or larger (4-6 cm: OR, 2.38 [95% CI, 1.21-4.67]; P = .01; ≥6 cm: OR, 2.46 [95% CI, 1.12-5.40]; P = .03).

Conclusions and Relevance Laparoscopic adrenalectomy remains safe for most adrenal disorders. Patient comorbidities, adrenal pathology, and tumor size are associated with the risk of complications and length of stay and should all be considered in selecting and preparing patients for surgery.

重要性 腹腔镜肾上腺切除术是大多数肾上腺疾病的金标准，在美国，其频率正在增加。尽管国家和行政数据库可以根据患者因素，合并症和机构差异进行调整，但仍缺乏可能会严重影响围手术期并发症发生率和住院时间（LOS）的特定疾病的具体数据。

目的 探讨腹腔镜肾上腺切除术后围手术期并发症及LOS的相关因素。

设计，设置和参加者 这项队列研究是在单个学术医学中心进行的，所有患者在1993年至2017年之间均由内分泌外科进行了腹腔镜肾上腺切除术。多变量线性和逻辑回归用于获得调整后的优势比（OR）。

主要结果和措施 主要结果是Dindo-Clavien评分为2或更高的围手术期并发症。次要结果是住院时间延长，即住院时间长于整个队列的第75个百分位。

结果 我们确定了640例接受了653例腹腔镜肾上腺切除术的患者，其中370例（56.7％）是女性。中位年龄为51岁（范围：5-88岁）。55例患者（8.4％）发生了76例Dindo-Clavien等级为2或更高的并发症，其中2例患者的术后死亡率（0.3％）。中位住院时间为1天（范围为0-32天）。与并发症增加相关的独立因素是美国麻醉医师学会3级或4级（OR，2.78 [95％CI，1.39-5.55]；P  <.01），糖尿病（OR，2.39 [95％CI，1.14-5.01]；P  = .02），转换为手助或开放手术（OR，5.32 [95％CI，1.84-15.41]；P  <.01），诊断为嗜铬细胞瘤（OR，4.31 [95％CI，1.43-13.05] ]; P = 0.01），肿瘤尺寸为6厘米或更大（OR为2.47 [95％CI，1.05-5.78]；P  = .04）。 美国麻醉医师协会3级或4级患者（65岁以上，OR为2.44 [95％CI，1.31-4.57]；P = .01）与更长的住院时间相关（OR为2.44 [95％CI，95％CI， 1.88-6.41]；P  <.01），任何程序转换（OR，63.28 [95％CI，12.53-319.59]；P  <.01），且肿瘤大小为4厘米或更大（4-6厘米：或，2.38 [95％CI，1.21-4.67]；P  ＝ 0.01；≥6cm ：OR，2.46 [95％CI，1.12-5.40；P  ＝ .03）。

结论和相关性 腹腔镜肾上腺切除术对于大多数肾上腺疾病仍然是安全的。患者合并症，肾上腺病理和肿瘤大小与并发症风险和住院时间有关，在选择和准备手术患者时均应考虑这些因素。