title: Risk factors for complications after adrenalectomy: results from a comprehensive national database.
abstract: OBJECTIVE
  Most knowledge regarding outcome after adrenal surgery stems from retrospective studies reported by highly specialized centres. The aim of this study was to report a national experience of adrenalectomy with particular attention to predictive factors for postoperative complications, conversion from endoscopic to open surgery and length of hospital stay.
  
  
  METHODS
  Adrenalectomies reported in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009-2014 were included. Risk factors for complications, conversion and hospital stay >3 days were assessed using univariable and multivariable logistic regression analysis.
  
  
  RESULTS
  There were 659 operations. Endoscopic adrenalectomy was performed in 513 (77.8%) operations and almost half of these were robotic assisted. The median length of hospital stay was 3 (range 1-30) days. There was no 30-day mortality. In 43 (6.6%) patients, at least one complication was registered. The only factor associated with complications in multivariable analysis was conversion to open surgery odds ratio (OR) 3.61 (95% confidence interval 1.07 to 12.12). The risk for conversion was associated with tumour size OR 1.03 (1.00 to 1.06) and with malignancy on histopathology OR 8.33 (2.12 to 32.07). Length of hospital stay increased in patients with operation of bilateral tumours OR 3.13, left-sided tumours OR 1.98, hyper secretion of catecholamines OR 2.32, conversion to open surgery OR 42.05 and open surgery OR 115.18.
  
  
  CONCLUSIONS
  The present study shows that endoscopic surgery is widely used. Complications were associated with conversion and the risk for conversion was associated with tumour size and malignant tumour. Hospital stay was short.
authors.affiliation: Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden. lo.hallin-thompson@med.lu.se.
authors.forename: Lo Hallin
authors.initials: LH
authors.lastname: Thompson
authors.affiliation: Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Nordenström
authors.affiliation: Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.affiliation: Research and Development Centre Skåne, Skåne University Hospital, 22185, Lund, Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Jacobsson
authors.affiliation: Department of Surgery, Skåne University Hospital, 22185, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Bergenfelz
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D061887:Conversion to Open Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Adrenalectomy; Complications; Conversion; Laparoscopic