title: Patients with Cushing's syndrome are care-intensive even in the era of laparoscopic adrenalectomy.
abstract: We report outcomes from laparoscopic adrenalectomy (LA) comparing patients with Cushing's syndrome with those with other adrenal pathology with respect to length of stay (LOS), overall complications, and financial implications. We conducted a retrospective review of 80 continuous patients (103 glands) undergoing LA. The clinical diagnoses were: hypercortisolism (Cushing' syndrome; n=33), hyperaldosteronism (Conn's syndrome; n=20), phaeochromocytoma (n=16), and neoplasm (others; n=11). Advanced care in the intermediate or intensive care unit was necessary in 27 patients, most frequently in our Cushing's population (16 of 33 [48%]). Six patients sustained major complications, including death in two patients; seven patients sustained minor complications. LOS was longer for patients with Cushing's syndrome (mean, 5.5 vs. 3.3 days; P = 0.024). Financially, patients with Cushing's syndrome had statistically higher total hospital (P = 0.009), advanced care (P = 0.002), and anesthetic costs (P = 0.005). LA in patients with Cushing's syndrome is associated with longer hospitalizations, more frequent major complications, and higher advanced care requirements, especially for patients undergoing bilateral adrenalectomy. Minor complications were infrequent and median LOS was brief regardless of diagnosis. Patients with Cushing's syndrome had higher costs for overall hospital charges, advanced care, and anesthesia.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Kissane
authors.forename: Juan C
authors.initials: JC
authors.lastname: Cendan
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D003480:Cushing Syndrome / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult