Abstract Purpose Adrenalectomy for pheochromocytoma (PHEO) presents a significant challenge due to the high incidence of early hospital readmission (ER). This study evaluated the incidence and risk factors of ER for PHEO within 30 days of adrenalectomy. Methods A retrospective analysis of 346 patients > 18 years with unilateral PHEO who underwent adrenalectomy between September 2012 and September 2024. The patients were categorised into ER (n = 49) and no ER (n = 297) groups. Logistic regression analyses were performed to predict risk factors for ER. Results The most common causes of ER were postoperative maintained hypotension (42.9%), bleeding (6.1%), ileus (24.5%), wound infection (4.1%), hyperkalemia (8.2%), pneumonia (2%), intra-abdominal abscess (2%), acute MI (4.1%), and colonic injury (6.1%). Most postoperative complications were Clavien-Dindo grade II (n = 40, 81.6%). Two perioperative deaths (4%) occurred in the ER group. Logistic regression showed that low body mass index (OR 0.849, 95% CI, 0.748–0.964; p = 0.012), tumor size < 5 cm (OR 0.096, 95% CI, 0.030–0.310; p < 0.001), and low ASA (OR 0.435, 95% CI, 0.249–0.761; p = 0.003) were associated with risk reduction for ER while malignancy (OR 5.302, 95% CI, 1.214–23.164; p = 0.027), open approach(OR 12.247, 95% CI, 5.227–28.694; p < 0.001), and intraoperative complications (OR 19.149, 95% CI, 7.091 51.710; p < 0.001) were associated with risk increase of ER. Conclusion Postoperatively maintained hypotension and ileus were the most common causes of ER. Low body mass index, tumour size < 5 cm, and low ASA were risk reductions for ER, while malignancy, open approach, and intraoperative com plications were the independent risk increase factors.