Analysis of influencing factors of operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy and establishment of predicting model / 国际外科学杂志

ABSTRACT

Objective:To explore the factors affecting the operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy, and to establish a predicting model.Methods:A total of 298 patients who underwent retroperitoneal laparoscopic adrenalectomy at Beijing Friendship Hospital, Capital Medical University from October 2017 to July 2022 were retrospectively analyzed.Observe and record the patient′s operative time, postoperative complications, and record the possible influencing factors, including gender, age, body mass index (BMI), tumor size, Mayo adhesive probability (MAP) score, and distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), distance from the lower pole of the adrenal tumor to the renal pedicle (DARP), distance between the skin and Gerota′s fascia (S-GF), perinephric fat distance (PNF), posterior adiposity index (PAI), thickness of waist fat, thickness of subcutaneous fat, etc. Univariate analysis was performed on the above influencing factors with the operative time as the dependent variable, and all variables with statistical significance were included in the linear regression analysis, and get the regression equation. Then take the occurrence of postoperative complications as the dependent variable, and the above-mentioned influencing factors as independent variables, and incorporate univariate and multivariate Logistic analysis to obtain the relevant influencing factors of postoperative complications, and use R software to establish a risk prediction nomogram model for postoperative complications.Results:Male patients ( P<0.001) with high BMI ( P=0.001), thick waist fat ( P=0.013), high MAP score ( P<0.001), and high PNF ( P<0.001) were expected to require longer operative time, and get the linear regression equation operative time=75.892+ 4.672×MAP score+ 13.574 (if male)+ 0.023×BMI+ 0.792×PNF+ 1.968×thickness of waist fat ( P<0.001); according to multivariate Logistic regression, short DARP ( P=0.003), high PAI ( P=0.002), and long operative time ( P=0.023) increase the risk of postoperative complications, and get a risk prediction nomogram model for postoperative complications. At the same time, postoperative complications were more likely to occur when the expected operative time was longer than 77.5 minutes. Conclusions:The prediction models of operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy established in this study provide an objective and reliable assessment. When the estimated operative time is longer than 77.5 minutes, the operation is more difficult and postoperative complications risk is higher and should be performed by more experienced doctors.