Surgical Endoscopy

, Volume 24, Issue 10, pp 2518–2526 | Cite as

Trends in adrenalectomy: a recent national review

  • 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. TsengEmail author



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.


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.


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).


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


Adrenalectomy Complications Mortality Nationwide inpatient sample 



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


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.


  1. 1.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033CrossRefPubMedGoogle Scholar
  2. 2.
    Pillinger SH, Bambach CP, Sidhu S (2002) Laparoscopic adrenalectomy: a 6-year experience of 59 cases. ANZ J Surg 72:467–470CrossRefPubMedGoogle Scholar
  3. 3.
    Hallfeldt KK, Mussack T, Trupka A, Hohenbleicher F, Schmidbauer S (2003) Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc 17:264–267CrossRefPubMedGoogle Scholar
  4. 4.
    Thompson GB, Grant CS, van Heerden JA, Schlinkert RT, Young WF Jr, Farley DR, Ilstrup DM (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122:1132–1136CrossRefPubMedGoogle Scholar
  5. 5.
    Imai T, Kikumori T, Ohiwa M, Mase T, Funahashi H (1999) A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg 178:50–53; discussion 54CrossRefPubMedGoogle Scholar
  6. 6.
    Prinz RA (1995) A comparison of laparoscopic and open adrenalectomies. Arch Surg 130:489–492; discussion 492–484PubMedGoogle Scholar
  7. 7.
    Smith CD, Weber CJ, Amerson JR (1999) Laparoscopic adrenalectomy: new gold standard. World J Surg 23:389–396CrossRefPubMedGoogle Scholar
  8. 8.
    Moinzadeh A, Gill IS (2005) Laparoscopic radical adrenalectomy for malignancy in 31 patients. J Urol 173:519–525CrossRefPubMedGoogle Scholar
  9. 9.
    Miccoli P, Raffaelli M, Berti P, Materazzi G, Massi M, Bernini G (2002) Adrenal surgery before and after the introduction of laparoscopic adrenalectomy. Br J Surg 89:779–782CrossRefPubMedGoogle Scholar
  10. 10.
    Chen B et al (2002) Port-site, retroperitoneal, and intraabdominal recurrence after laparoscopic adrenalectomy for apparently isolated metastasis. J Urol 168:2528–2529CrossRefPubMedGoogle Scholar
  11. 11.
    Henry JF, Sebag F, Iacobone M, Mirallie E (2002) Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg 26:1043–1047CrossRefPubMedGoogle Scholar
  12. 12.
    Kebebew E, Siperstein AE, Clark OH, Duh QY (2002) Results of laparoscopic adrenalectomy for suspected and unsuspected malignant adrenal neoplasms. Arch Surg 137:948–951; discussion 952–943CrossRefPubMedGoogle Scholar
  13. 13.
    Heniford BT, Arca MJ, Walsh RM, Gill IS (1999) Laparoscopic adrenalectomy for cancer. Semin Surg Oncol 16:293–306CrossRefPubMedGoogle Scholar
  14. 14.
    Young WF Jr (2000) Management approaches to adrenal incidentalomas: a view from Rochester, Minnesota. Endocrinol Metab Clin North Am 29:159–185 xCrossRefPubMedGoogle Scholar
  15. 15.
    Prinz RA, Brooks MH, Churchill R, Graner JL, Lawrence AM, Paloyan E, Sparagana M (1982) Incidental asymptomatic adrenal masses detected by computed tomographic scanning: is operation required? JAMA 248:701–704CrossRefPubMedGoogle Scholar
  16. 16.
    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B (1995) Incidentally discovered adrenal masses. Endocr Rev 16:460–484PubMedGoogle Scholar
  17. 17.
    Gill IS (2001) The case for laparoscopic adrenalectomy. J Urol 166:429–436CrossRefPubMedGoogle Scholar
  18. 18.
    Healthcare Utilization Project (HCUP) (2008) Overview of the Nationwide Inpatient Sample (NIS). Retrieved 15 September 2008
  19. 19.
    Public Health Service (1998) International classification of diseases, ninth revision, clinical modification. Public Health Service, U.S. Department of Health and Human Services, Washington, DCGoogle Scholar
  20. 20.
    Smith JK, McPhee JT, Hill JS, Whalen GF, Sullivan ME, Litwin DE, Anderson FA, Tseng JF (2007) National outcomes after gastric resection for neoplasm. Arch Surg 142:387–393CrossRefPubMedGoogle Scholar
  21. 21.
    Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183:237–241CrossRefPubMedGoogle Scholar
  22. 22.
    McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF (2007) Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 246:246–253CrossRefPubMedGoogle Scholar
  23. 23.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  24. 24.
    Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619CrossRefPubMedGoogle Scholar
  25. 25.
    Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI (2000) Identification of in-hospital complications from claims data: is it valid? Med Care 38:785–795CrossRefPubMedGoogle Scholar
  26. 26.
    Brunt LM, Moley JF, Doherty GM, Lairmore TC, DeBenedetti MK, Quasebarth MA (2001) Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 130:629–634; discussion 634–625CrossRefPubMedGoogle Scholar
  27. 27.
    Schell SR, Talamini MA, Udelsman R (1999) Laparoscopic adrenalectomy for nonmalignant disease: improved safety, morbidity, and cost-effectiveness. Surg Endosc 13:30–34CrossRefPubMedGoogle Scholar
  28. 28.
    Saunders BD, Wainess RM, Dimick JB, Upchurch GR, Doherty GM, Gauger PG (2004) Trends in utilization of adrenalectomy in the United States: have indications changed? World J Surg 28:1169–1175CrossRefPubMedGoogle Scholar
  29. 29.
    Brunt LM (2002) The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc 16:252–257CrossRefPubMedGoogle Scholar
  30. 30.
    Lee J, El-Tamer M, Schifftner T, Turrentine FE, Henderson WG, Khuri S, Hanks JB, Inabnet WB III (2008) Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg 206:953–959; discussion 959–961CrossRefPubMedGoogle Scholar
  31. 31.
    Gagner M, Lacroix A, Prinz RA, Bolte E, Albala D, Potvin C, Hamet P, Kuchel O, Querin S, Pomp A (1993) Early experience with laparoscopic approach for adrenalectomy. Surgery 114:1120–1124; discussion 1124–1125PubMedGoogle Scholar
  32. 32.
    Brunt LM, Langer JC, Quasebarth MA, Whitman ED (1996) Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 172:596–599; discussion 599–601CrossRefPubMedGoogle Scholar
  33. 33.
    Voitk AJ, Tsao SG, Ignatius S (2001) The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 182:250–253CrossRefPubMedGoogle Scholar
  34. 34.
    Guerrieri M, Campagnacci R, De Sanctis A, Baldarelli M, Coletta M, Perretta S (2008) The learning curve in laparoscopic adrenalectomy. J Endocrinol Invest 31:531–536PubMedGoogle Scholar
  35. 35.
    Tessier DJ, Iglesias R, Chapman WC, Kercher K, Matthews BD, Gorden DL, Brunt LM (2009) Previously unreported high-grade complications of adrenalectomy. Surg Endosc 23:97–102CrossRefPubMedGoogle Scholar
  36. 36.
    Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91:1259–1274CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Melissa M. Murphy
    • 1
  • Elan R. Witkowski
    • 1
  • Sing Chau Ng
    • 1
  • Theodore P. McDade
    • 1
  • Joshua S. Hill
    • 1
  • Anne C. Larkin
    • 1
  • Giles F. Whalen
    • 1
  • Demetrius E. Litwin
    • 1
  • Jennifer F. Tseng
    • 1
    Email author
  1. 1.Department of Surgery, Surgical Outcomes Analysis and Research (SOAR)University of Massachusetts Medical SchoolWorcesterUSA

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