Predictors of complication after adrenalectomy

Srougi, Victor; Barbosa, João Arthur Brunhara Alves; Massaud, Isaac; Cavalcante, Isadora Pontes; Tanno, Fabio Y; Almeida, Madson Q.; Srougi, Miguel; Fragoso, Maria Candida Barisson Villares; Chambô, José Luis

doi:10.1590/s1677-5538.ibju.2018.0482

Cited by 7 publications

(12 citation statements)

References 26 publications

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“…A similar study from Saudi Arabia on 55 patients showed similar results where the mean age of patients was 49.91 years [ 9 ]. Other studies also report similar findings where more than 35% of the patients were aged between 41 and 50 years [ 4 , 14 ]. Abdominal pain and severe headaches were the most frequent presenting complaints of the patients.…”

Section: Discussionsupporting

confidence: 70%

“…Meticulous intraoperative hemostasis management and accurate operative technique are the greatest challenges during open adrenalectomy [ 19 ]. Poor intraoperative hemostasis leads to hematoma formation that may ultimately translate into hypovolemic shock or re-exploration [ 10 , 14 ]. Improvement in surgical techniques and limiting blood loss can significantly reduce this complication.…”

Section: Discussionmentioning

confidence: 99%

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The Spectrum of Postoperative Complications and Outcomes After Open Adrenalectomy: An Experience From a Developing Country

Zubair¹,

Arif²,

Razzaq³

et al. 2022

Cureus

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BackgroundOpen adrenalectomy is an invasive surgical procedure that is commonly performed for adrenal gland neoplasms in developing countries. Due to its complexity, the patients are predisposed to a number of complications and dismal outcomes. The objective of our study is to assess different characteristics of patients undergoing open adrenalectomy, including their histology, postoperative complications, and outcomes. MethodsThis retrospective cross-sectional study included 107 patients undergoing open adrenalectomy for primary adrenal gland neoplasms. Patients with bilateral involvement, metastatic disease, or unresectable tumors were excluded. Patients were evaluated for different features that included demographic data, tumor properties, postoperative outcomes, and complications. ResultsOut of 107 patients, 45 (42.1%) were females. The mean age of the patients was 47.53 ± 8.45 years. Abdominal pain and severe headaches were the most common presenting complaints. A total of 96 (89.7%) tumors were benign, while 11 (10.3%) were malignant. Upon the histopathological examination of the resected specimen, adrenal adenoma was present in 49 (45.8%) cases, while adrenal pheochromocytoma was present in 41 (38.3%) cases. A total of 51 patients developed different postoperative complications including surgical site infections (22.4%), atelectasis (11.2%), deep venous thrombosis (7.5%), and retroperitoneal hematoma (5.6%). In-hospital mortality occurred in three (2.8%) patients. ConclusionSurgical site infections, atelectasis, deep venous thrombosis, and retroperitoneal hematoma were frequent postoperative complications after open adrenalectomy. These complications increase morbidity and mortality, especially in developing countries. Improved surgical techniques, intraoperative hemostasis, and multidisciplinary approach can yield favorable postoperative outcomes.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

The Spectrum of Postoperative Complications and Outcomes After Open Adrenalectomy: An Experience From a Developing Country

Zubair¹,

Arif²,

Razzaq³

et al. 2022

Cureus

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“…In line with our results, Srougi et al [21] found that the mean Charlson score was 3.6 ± 1.3 in the older group and 0.89 ± 1.0 in the younger group, and elderly patients had a higher rate of postoperative complications (60% vs 18.9%, p = 0.01), but they did not adjusted the risk of complications for comorbidities as we did. Nevertheless, in a more recent study [22], the same authors included a larger number of patients, and they performed a multivariate analysis including age and comorbidities, observing that patients age (p = 0.004), comorbidities (p = 0.003) and pathological diagnosis (p = 0.003) were independent predictors of postoperative complications. In contrast with our results, a recent study comparing laparoscopic outcomes in elderly and young pheochromocytoma patients [23], did not nd any difference in terms of haemodynamic changes during surgery and complications.…”

Section: Surgical Outcomesmentioning

confidence: 99%

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

et al. 2021

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Purpose: To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery.Methods: A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classi ed according to Clavien-Dindo scale.Results: One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P=0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2±11.16 vs 6.2±6.82, P<0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n=16), followed by hypoglycaemia in 6 patients and acute renal failure in 4 patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. Conclusion:Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications. Introduction:Pheochromocytomas are rare neuroendocrine tumours that produce catecholamines [1]. They are a lifethreatening condition because catecholamine secretion is unpredictable, resulting in hypertension, arrhythmia, and/or other cardiovascular complications [2]. Surgery represents the primary treatment for pheochromocytomas [1]. Due to improvements in perioperative treatment, anaesthesia and surgical techniques, the mortality has dropped markedly in the last thirty years, but the risk of cardiovascular complications remains still high [3]. Intraoperative complications, including hypertensive crisis, hemodynamic instability and tachyarrhythmias, among others, have been reported in 30-50% of the pheochromocytoma surgeries [4][5][6]. The main postoperative major complications are prolonged hypotension and rebound hypoglycaemia [1]. However, postsurgical complications are usually less reported in pheochromocytoma studies, and are usually described in around 20-30% of the patients in recent series [4][7][8][9].Few studies have evaluated the grade of these complications using validate scales as the Clavien-Dindo score [4][10][9][8]. Moreover, studies evaluating risk factors for p...

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“…The spectrum of pathologies for non-malignant adrenal masses includes non-functioning adenoma, aldosteronism, hypercortisolism, and pheochromocytoma. Multiple studies explored the leading causes of postoperative complications, and no significant correlation was found between the pathology and postoperative complications 17,23,31. Pheochromocytoma was found to be associated with higher conversion rate, as reported by Srougi et al23 VASQIP database lacks details about specific preoperative laboratory values to specify the biochemical profile of the adrenal masses.…”

Section: Discussionmentioning

confidence: 96%

“…Adrenal mass size represents one of the major factors in the selection of the surgical approach, and a predictor of difficulty, conversion, and complications 15,21–24. Previous reports suggested that the cutoff for performing a minimal invasive approach is <6 cm due to the increased risk of malignancy 4,13,25–27.…”

Section: Discussionmentioning

confidence: 99%

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Shahait

Saleh

Weaver

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies.Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes.Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class ≥ III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥ 1 complication. LA was performed in 70.9% ( 1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥ III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion:LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.

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Predictors of complication after adrenalectomy

Cited by 7 publications

References 26 publications

The Spectrum of Postoperative Complications and Outcomes After Open Adrenalectomy: An Experience From a Developing Country

The Spectrum of Postoperative Complications and Outcomes After Open Adrenalectomy: An Experience From a Developing Country

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

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