title: Influence of adrenal pathology on perioperative outcomes: a multi-institutional analysis.
abstract: BACKGROUND
  Endoscopic or open adrenalectomies are performed for variable pathologies. We investigated if adrenal pathology affects perioperative outcomes independent of operative approach.
  
  
  METHODS
  A multi-institutional retrospective review of 345 adrenalectomies was performed. A multivariate analysis was utilized.
  
  
  RESULTS
  Pathology groups included benign non-pheochromocytoma tumors (50.4%), pheochromocytomas (41%), adrenocortical carcinomas (5.2%), and metastatic tumors (3.4%). Controlling for age, body mass index, tumor size, procedure type, and pathology, pheochromocytomas exhibited greater blood loss (92 mL more, P = .007) and operative times (33 min more, P < .001) than benign non-pheochromocytoma tumors. Metastatic tumors demonstrated longer operative times (53 min more, P = .013). Open adrenalectomy was associated with greater blood loss (396 mL more, P = .001), transfusion requirement (P = .021), operative times (79 min more, P < .001), hospital stay (6.6 days more, P < .001) and complications (P < .001) when compared with endoscopic adrenalectomy.
  
  
  CONCLUSIONS
  The type of adrenal pathology appears to influence blood loss and operative time but not complications in patients undergoing adrenalectomy. Open adrenalectomy remains a major driver of adverse perioperative outcomes.
authors.affiliation: Division of General Surgery, Vanderbilt University, Nashville, TN, USA. Electronic address: colleen.m.kiernan@vanderbilt.edu.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Kiernan
authors.affiliation: Division of General Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Myrick C
authors.initials: MC
authors.lastname: Shinall
authors.affiliation: Division of Endocrine Surgery, University of Puerto Rico, San Juan, PR, USA.
authors.forename: William
authors.initials: W
authors.lastname: Mendez
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Peters
authors.affiliation: Division of Surgical Oncology/Endocrine Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Broome
authors.affiliation: Division of Surgical Oncology/Endocrine Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Adrenalectomy; Adrenocortical carcinoma; Metastatic adrenal lesions; Outcomes; Pheochromocytoma