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Adrenal surgery in the elderly: too risky?
C Y Lo1, J A van Heerden, C S Grant
1Department Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
World Journal of Surgery
|March 1, 1996
Summary
Adrenal surgery in patients 65 and older is safe, with acceptable morbidity and mortality, except for adrenocortical carcinoma. The Goldman cardiac risk score effectively predicts outcomes for elderly patients undergoing adrenalectomy.
Area of Science:
- Endocrinology
- Surgical Oncology
- Geriatric Medicine
Background:
- Elderly patients are often excluded from adrenal surgery due to perceived high risks.
- Objective data is needed to assess the safety and outcomes of adrenalectomy in older adults.
Purpose of the Study:
- To evaluate the morbidity and mortality associated with adrenalectomy in patients aged 65 years and older.
- To identify predictors of postoperative outcomes in this patient population.
Main Methods:
- Retrospective review of 85 patients (aged 65-84) who underwent adrenalectomy between 1984 and 1993.
- Analysis included American Society of Anesthesiologists (ASA) classification and the modified Goldman cardiac risk scheme.
- Kaplan-Meier methods were used for survival estimation.
Main Results:
- Overall operative mortality was 7%. Patients with adrenocortical carcinoma had significantly higher mortality (43%).
- Postoperative complications occurred in 22% of patients, with a 6% reoperation rate.
- Two- and five-year survival rates were 86% and 84%, respectively. Goldman class II or greater predicted increased morbidity and mortality.
Conclusions:
- Adrenal surgery in elderly patients is feasible with acceptable outcomes, excluding adrenocortical carcinoma.
- The Goldman multifactorial cardiac risk scheme is a reliable tool for predicting postoperative outcomes in this demographic.