title: Adrenalectomy in older Americans has increased morbidity and mortality: an analysis of 6,416 patients.
abstract: BACKGROUND
  The incidence of adrenal tumors increases with age. We examined the impact of older age (>60 years) on clinical and economic outcomes after adrenalectomy.
  
  
  METHODS
  Adult patients who underwent adrenalectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003-2008 were categorized into age groups: ≤60 years, 61-70 years, and >70 years. Outcomes were compared using χ(2) and ANOVA; multivariate regression was used to assess the independent effect of older age on adrenalectomy outcomes.
  
  
  RESULTS
  There were 6,416 patients: 21.9% were 61-70 years, and 12.9% were >70 years. Compared with patients ≤60 years, patients 61-70 and >70 years had more complications (14.1% vs. 19.9 and 22.6%; p < 0.001) and mortality (0.4% vs. 1.3 and 2.3%; p < 0.001), longer mean length of stay (LOS) (3.3 vs. 4.0 and 4.9 days; p < 0.001), and higher mean costs ($12,307 vs. $13,226 and $14,649; p < 0.001). After adjustment, older age remained independently associated with sustaining one or more complications after adrenalectomy (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1-1.7, for patients 61-70 years; OR 1.7, 95% CI 1.3-2.2 for patients >70 years) and longer adjusted LOS (1-day difference, p < 0.01). Age >70 years was independently associated with increased mortality after adrenalectomy (OR 2.8; 95% CI 1.4-5.6). Complications, LOS, and costs were reduced if patients underwent surgery by high-volume compared with low-volume surgeons.
  
  
  CONCLUSIONS
  Older age seems to be independently associated with adverse short-term clinical and economic outcomes after adrenalectomy. Enhanced access to high-volume surgeons is a potentially modifiable factor of particular importance in these patients.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St, Tompkins 208, New Haven, CT, USA.
authors.forename: Hadiza S
authors.initials: HS
authors.lastname: Kazaure
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome