Risk factors for postoperative respiratory complications following retroperitoneal laparoscopic adrenalectomy: a cohort study.

Abstract

Background: Retroperitoneal laparoscopic adrenalectomy (RLA) is a minimally invasive technique known for its benefits, including reduced pain and quicker recovery. Despite these advantages, respiratory complications remain a notable concern, highlighting the importance of identifying risk factors to enhance perioperative care. This study aimed to explore the determinants of respiratory complications following RLA.

Methods: A retrospective analysis was conducted on the clinical data of 569 patients who underwent RLA for adrenal lesions in the Department of Urology at Beijing Anzhen Hospital from January 2012 to December 2021. The data collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, operative time, estimated intraoperative blood loss, tumor laterality, type of resection, lesion size, preoperative comorbidities and postoperative complications. Univariate and multivariate logistic regression models were used to identify risk factors for respiratory complications following RLA. The area under the receiver operating characteristic (ROC) curve with area under the curve (AUC) was calculated to evaluate the predictive value of relevant factors for respiratory complications.

Results: A total of 30 patients (5.27%) developed postoperative respiratory complications following RLA, including 16 cases of respiratory infection (2.8%), 9 cases of postoperative cough requiring antitussive medication (1.6%), 3 cases of bronchial asthma (0.5%), and 2 cases of respiratory failure (0.4%). Univariate logistic regression analysis identified prolonged operative time [odds ratio (OR) =1.007, P=0.043], preoperative respiratory disease comorbidity (OR =6.005, P<0.001), and right-sided RLA (OR =3.544, P=0.002) as associated with an increased risk of postoperative respiratory complications. Multivariate logistic regression analysis showed that preoperative respiratory disease comorbidity (OR =7.243, P<0.001) and right-sided RLA (OR =4.227, P=0.001) were independent risk factors for postoperative respiratory complications. The AUC for the predictive model, which included operative time, preoperative respiratory diseases, and right-sided RLA, was 0.752 (95% CI: 0.657-0.848).

Conclusions: Respiratory complications following RLA are associated with factors such as operative time, preoperative respiratory disease comorbidity, and right-sided RLA. Identifying these risk factors preoperatively may help optimize surgical planning and reduce the incidence of postoperative complications.