, Volume 18, Issue 10, pp 2714-2721
Date: 05 May 2011

Adrenalectomy in Older Americans has Increased Morbidity and Mortality: An Analysis of 6,416 Patients

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Abstract

Background

The incidence of adrenal tumors increases with age. We examined the impact of older age (>60 years) on clinical and economic outcomes after adrenalectomy.

Methods

Adult patients who underwent adrenalectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003–2008 were categorized into age groups: ≤60 years, 61–70 years, and >70 years. Outcomes were compared using χ2 and ANOVA; multivariate regression was used to assess the independent effect of older age on adrenalectomy outcomes.

Results

There were 6,416 patients: 21.9% were 61–70 years, and 12.9% were >70 years. Compared with patients ≤60 years, patients 61–70 and >70 years had more complications (14.1% vs. 19.9 and 22.6%; p < 0.001) and mortality (0.4% vs. 1.3 and 2.3%; p < 0.001), longer mean length of stay (LOS) (3.3 vs. 4.0 and 4.9 days; p < 0.001), and higher mean costs ($12,307 vs. $13,226 and $14,649; p < 0.001). After adjustment, older age remained independently associated with sustaining one or more complications after adrenalectomy (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1–1.7, for patients 61–70 years; OR 1.7, 95% CI 1.3–2.2 for patients >70 years) and longer adjusted LOS (1-day difference, p < 0.01). Age >70 years was independently associated with increased mortality after adrenalectomy (OR 2.8; 95% CI 1.4–5.6). Complications, LOS, and costs were reduced if patients underwent surgery by high-volume compared with low-volume surgeons.

Conclusions

Older age seems to be independently associated with adverse short-term clinical and economic outcomes after adrenalectomy. Enhanced access to high-volume surgeons is a potentially modifiable factor of particular importance in these patients.

A portion of the results of this study was presented as a poster at the annual meeting of the American Association of Endocrine Surgeons, April 10–12, 2011, Houston, Texas.