P. P. Parikh1, G. A. Rubio1, J. C. Farra1, J. I. Lew1 1University Of Miami Miller School Of Medicine,Endocrine Surgery,Miami, FL, USA
Introduction: Adrenal adenomas are benign neoplasms commonly discovered incidentally on radiologic studies, and >70% are hormonally inactive. The remaining subset of adrenal adenomas, however, is commonly associated with excess production of aldosterone, cortisol or catecholamines. Perioperative outcomes following adrenalectomy for excess hormone producing or “hormonally active” adrenal tumors have not been well defined. This study examines in-hospital outcomes after unilateral adrenalectomy in patients with hormonally active adrenal tumors.
Methods: A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample database (2006-2011) to identify patients who underwent unilateral open or laparoscopic adrenalectomy for a hormonally active or inactive adrenal adenoma. Malignant adrenal tumors were excluded. Patient demographic, comorbidities and postoperative complications were evaluated by univariate and risk-adjusted multivariate logistic regression. Univariate analyses included two-tailed Chi-square and t-tests.
Results: Of 27,312 patients who underwent adrenalectomy during the 5-year period, 78% (n=21,279) had hormonally inactive and 22% (n=6,033) had hormonally active adrenal tumors. Among patients with hormonally active adrenal tumors, 65% (n=4000) had primary hyperaldosteronism (Conn’s Syndrome), 33% (n=1996) had hypercortisolism (Cushing’s Syndrome) and 1.4% (n=85) had pheochromocytoma. Patients with pheochromocytoma had a higher rate of chronic lung disease and malignant hypertension compared to the remaining hormonally active adrenal patients (18% vs 10%, 6% vs 2%; P<0.01). Pheochromocytoma patients also required more blood transfusions intraoperatively than patients with other hormonally active tumors (21% vs 3%; P<0.01). Pheochromocytoma patients also had more postoperative cardiac (6% vs 0.5%; P<0.01) and respiratory complications (17% vs 7%; P<0.01) than patients with other hormonally active tumors. Mean length of stay was 5 versus 3 days for pheochromocytoma patients compared to the remaining adrenal patients, respectively (P<0.01). Furthermore, total in-hospital cost was approximately $50,000 for pheochromoctyoma patients compared to $39,000 for their counterparts, respectively (P<0.01). On risk-adjusted multivariate logistic regression, pheochromocytoma had an independently higher risk for intraoperative blood transfusion (4.2, 95% CI 2.4-7.2) and postoperative respiratory (1.9, 95% CI 1.0-3.3) and cardiac (7.6, 95% CI 2.8-20.2) complications.
Conclusion: Among benign hormonally active adrenal tumors, patients with pheochromocytoma have a high rate of preoperative comorbidities, contributing to significant postoperative cardiopulmonary complications that ultimately lead to longer and more expensive hospitalizations. Such patients at high risk should undergo appropriate preoperative medical optimization and counseling in preparation for adrenalectomy.