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Trends in adrenalectomy: a recent national review

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Abstract

Background

Adrenalectomy remains the definitive therapy for most adrenal neoplasms. Introduced in the 1990s, laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality. This study aimed to evaluate national adrenalectomy trends, including major postoperative complications and perioperative mortality.

Methods

The Nationwide Inpatient Sample was queried to identify all adrenalectomies performed during 1998–2006. Univariate and multivariate logistic regression were performed, with adjustments for patient age, sex, comorbidities, indication, year of surgery, laparoscopy, hospital teaching status, and hospital volume. Annual incidence, major in-hospital postoperative complications, and in-hospital mortality were evaluated.

Results

Using weighted national estimate, 40,363 patients with a mean age of 54 years were identified. Men made up 40% of these patients, and 77% of the patients were white. The majority of adrenalectomies (83%) were performed for benign disease. The annual volume of adrenalectomies increased from 3,241 in 1998 to 5,323 in 2006 (p < 0.0001, trend analysis). The overall in-hospital mortality was 1.1%, with no significant change. Advanced age (<45 years as the referent; ≥65 years: adjusted odds ratio [AOR], 4.10; 95%; confidence Interval [CI], 1.66–10.10) and patient comorbidities (Charlson score 0 as the referent; Charlson score ≥2: AOR, 4.33; 96% CI, 2.34–8.02) were independent predictors of in-hospital mortality. Indication, year, hospital teaching status, and hospital volume did not independently affect perioperative mortality. Major postoperative in-hospital complications occurred in 7.2% of the cohort, with a significant increasing trend (1998–2000 [5.9%] vs 2004–2006 [8.1%]; p < 0.0001, trend analysis). Patient comorbidities (Charlson score 0 as the referent; Charlson score ≥2: AOR, 4.77; 95% CI, 3.71–6.14), recent year of surgery (1998–2000 as the referent; 2004–2006: AOR, 1.40; 95% CI, 1.09–1.78), and benign disease (malignant disease as the referent; benign disease: AOR, 1.98; 95% CI, 1.55–2.53) were predictive of major postoperative complications at multivariable analyses, whereas laparoscopy was protective (no laparoscopy as the referent; laparoscopy: AOR, 0.62; 95% CI, 0.47–0.82).

Conclusion

Adrenalectomy is increasingly performed nationwide for both benign and malignant indications. In this study, whereas perioperative mortality remained low, major postoperative complications increased significantly.

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Acknowledgments

The contributions of Dr. Fred Anderson in database provision and statistical analyses are gratefully appreciated.

Disclosures

Melissa Murphy, Elan Witkowski, Sing-Chau Ng, Theodore McDade, Joshua Hill, Anne Larkin, Giles Whalen, Demetrius Litwin, and Jennifer Tseng have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Surgical Outcomes Analysis and Research (SOAR), University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA, 01655, USA

    Melissa M. Murphy, Elan R. Witkowski, Sing Chau Ng, Theodore P. McDade, Joshua S. Hill, Anne C. Larkin, Giles F. Whalen, Demetrius E. Litwin & Jennifer F. Tseng

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  1. Melissa M. Murphy
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  2. Elan R. Witkowski
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Correspondence to Jennifer F. Tseng.

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Murphy, M.M., Witkowski, E.R., Ng, S.C. et al. Trends in adrenalectomy: a recent national review. Surg Endosc 24, 2518–2526 (2010). https://doi.org/10.1007/s00464-010-0996-z

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  • DOI: https://doi.org/10.1007/s00464-010-0996-z

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