Mp69-18 elective Adrenalectomy in Elderly Patients: Proceed With Caution

Abstract

INTRODUCTION AND OBJECTIVES: Advances in surgical safety have made many procedures which were once considered too morbid into reasonable treatment options for the elderly population. However, as the US population ages, it is important to recognize that there still remain increased risks associated with relatively safe elective surgeries when performed in the elderly. Here, we sought to evaluate the perioperative outcomes of elective adrenalectomies when performed in elderly patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2012) was queried using Current Procedural Terminology (CPT) codes for adrenal gland explorations (60540), laparoscopic adrenalectomy (60650), and adrenal gland exploration with excision of adjacent/ retroperitoneal tumor (60545). Only surgeries performed by urologic surgeons were included. Advanced age was defined >70 years old. Prolonged length of stay (pLOS), prolonged operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. pOT and pLOS were defined as an operating time and hospital length-of-stay greater than the 75th percentile, respectively (pOT[193.25 minutes and pLOS[ 4 days). RESULTS: Out of 291 patients who underwent an elective adrenalectomy, 44 patients (15.1%) were older than 70 years. The overall post-operative complication rate for elective adrenalectomy for all ages was 6.2%. We found an association between advanced age and major post operative complications, including return to OR (p<0.0001), septic shock (p [ 0.0008), pneumonia (0.0122), reintubation (p [ 0.0008), ventilator support for >48 hrs (p [ 0.0122), and readmission (p [ 0.0010). Advanced age was also associated with minor complications including UTI (p [ 0.0008). CONCLUSIONS: Overall, elective adrenalectomies are associated with a low rate of complications. However, this procedure should be undertaken with caution in the elderly as they are at a significantly higher risk of developing a major post operative complications. Therefore, special consideration should be made to medically optimize these patients perioperatively.