Document Detail


Adrenal surgery in the elderly: too risky?
MedLine Citation:
PMID:  8661847     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Surgical treatment for adrenal disease may be withheld from elderly patients because of concern about prohibitive operative morbidity and mortality. To obtain objective data in our practice, we analyzed the results of adrenalectomy for patients aged 65 years and older. From 1984 to 1993 there were 85 patients (41 men, 44 women) with ages ranging from 65 to 84 years (median 69 years) who underwent adrenalectomy for Cushing syndrome (n = 19), pheochromocytoma (n = 16), adrenocortical carcinoma (n = 7), benign adenoma (n = 26), or primary hyperaldosteronism (n = 17) at our institution. Median follow-up was 26 months (range 1 month to 9.1 years). A retrospective review with respect to preoperative risks and postoperative morbidity and mortality was performed utilizing the American Society of Anesthesiologists (ASA) physical status classification and the modified Goldman multifactorial cardiac risk scheme. Survival was estimated by the Kaplan-Meier methods. Operative mortality was 7% (six patients). No patients with pheochromocytoma or primary hyperaldosteronism died during the postoperative period. Patients undergoing adrenalectomy for adrenocortical carcinoma had a significantly higher operative mortality (43%) (p = 0.006). Postoperative complications developed in 19 patients (22%), and there was a reoperation rate of 6% (5 patients). Nineteen percent of patients required postoperative intensive care admission and had a median stay of 2 days (range, 1-38 days). Median hospital stay was 7 days (range 3-47 days). Seventy-three patients (86%) remained alive at study completion. Two- and five-year survivals were 86% and 84%, respectively. Goldman class II or greater was an excellent predictor of increased morbidity (p = 0.032) and mortality (p = 0.036). With the exception of adrenocortical carcinoma, adrenal surgery for elderly patients can be performed with acceptable morbidity and mortality. The Goldman multifactorial cardiac risk scheme reliably predicts postoperative outcome in this elderly group of patients.
Authors:
C Y Lo; J A van Heerden; C S Grant; J A Söreide; M A Warner; D M Ilstrup
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  20     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:    1996 Mar-Apr
Date Detail:
Created Date:  1996-12-06     Completed Date:  1996-12-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  368-73; discussion 374     Citation Subset:  IM    
Affiliation:
Department Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
ACTH Syndrome, Ectopic / mortality,  surgery
Adenoma / mortality,  surgery
Adrenal Cortex Neoplasms / mortality,  surgery
Adrenal Gland Neoplasms / mortality,  surgery*
Adrenalectomy*
Aged
Aged, 80 and over
Cause of Death*
Female
Humans
Male
Postoperative Complications / mortality*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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