title: Immediate laparoscopic adrenalectomy versus observation: cost evaluation for incidental adrenal lesions with atypical imaging characteristics.
abstract: BACKGROUND
  Because of controversy in the management of nonfunctional adrenal masses <6 cm with lipid-poor imaging characteristics, the study was conducted to compare the costs of observation versus immediate laparoscopic adrenalectomy.
  
  
  METHODS
  A total of 370 patients who were evaluated for incidental adrenal masses between January 1999 and December 2007 were identified, and 32 (8.7%) patients had lesions with imaging characteristics that were inconsistent with a benign adenoma (ie, atypical appearing). Sixteen patients underwent immediate surgery and 16 had observation with serial imaging and biochemical studies. The associated total costs were subjected to intention-to-treat analysis.
  
  
  RESULTS
  In the observation cohort, 7 patients converted and underwent adrenalectomy after a mean of 13.1 months. Initially, costs of immediate surgery exceeded those of observation ($12,015.72 vs $11,601.18, P = .10). After projecting costs of annual surveillance, a cost advantage for immediate surgery was demonstrated after 9 years (P = .02).
  
  
  CONCLUSIONS
  In patients with <6 cm atypical-appearing adrenal lesions, the costs of surgery and of observation are initially equal. After 9 years, the costs of surveillance exceed that of initial laparoscopic adrenalectomy.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Adrienne L
authors.initials: AL
authors.lastname: Melck
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Michaele J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
mesh_terms: D000236:Adenoma / Q000191:economics / Q000601:surgery; D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000191:economics / Q000601:surgery; D000315:Adrenalectomy / Q000191:economics* / Q000379:methods*; D000328:Adult; D000368:Aged; D003560:Cysts / Q000191:economics / Q000601:surgery; D005260:Female; D005729:Ganglioneuroma / Q000191:economics / Q000601:surgery; D006470:Hemorrhage / Q000191:economics / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018209:Myelolipoma / Q000191:economics / Q000601:surgery; D011159:Population Surveillance; D011859:Radiography; D014481:United States; D057832:Watchful Waiting / Q000191:economics*