Outcomes after adrenalectomy in elderly patients; a propensity score matched analysis

Area of Science:

• Endocrinology
• Surgical Oncology
• Geriatric Medicine

Background:

• Adrenal masses are increasingly detected, posing a surgical dilemma in older patients due to frailty and potential postoperative complications.
• Surgical decisions for elderly patients with adrenal masses require careful consideration of risks versus benefits.

Purpose of the Study:

• To compare the postoperative course and complication rates of adrenalectomy in patients aged 70 years and older versus a younger cohort.
• To evaluate if advanced age is a contraindication for adrenalectomy.

Main Methods:

• Single-center retrospective study of patients undergoing adrenalectomy from 2000-2020.
• Propensity-score matching of 77 elderly patients (≥70 years) with 77 younger patients (<70 years) based on hormonal status, malignancy, surgical approach, and year of surgery.
• Analysis of serious complications (Clavien-Dindo ≥3), overall complication rates, hospital stay, and mortality.

Main Results:

• No significant difference in serious complications (9.1% vs 6.5%) or overall complication rates (44.2% vs 40.3%) between elderly and younger patients.
• Similar hospital admission duration and mortality rates in both age groups.
• Elderly patients had a higher incidence of cardiovascular complications (6.7% vs. not specified, p=0.039).

Conclusions:

• Adrenalectomy in patients aged 70 and older is associated with a postoperative course and complication profile comparable to younger patients.
• Most postoperative complications in the elderly were minor, with minimal mortality.
• Advanced age should not be a barrier to considering adrenalectomy for adrenal masses.