Department of Surgery, Temple University Hospital, Philadelphia, PA.
Department of Surgery, Temple University Hospital, Philadelphia, PA. Electronic address: https://twitter.com/terrypgao.
Surgery. 2023 Oct;174(4):819-827. doi: 10.1016/j.surg.2023.06.007. Epub 2023 Jul 16.
Adrenalectomy is well tolerated with low complication rates. It is unclear if these excellent outcomes are consistent across all age groups.
The 2015-2020 American College of Surgeons National Surgical Quality Improvement Program datasets were used. Patients who underwent adrenalectomy were identified and grouped based on age: ≤60, 61 to 70, 71 to 80, and >80 years. Patient characteristics, surgical indications, operative characteristics, and postoperative outcomes were compared between age groups. Primary outcome measures were mortality, morbidity, postoperative length of stay, non-home discharge, and unplanned readmission. Multivariable logistic regression analysis was performed.
Adrenalectomy was performed on 6,114 patients. Younger patients more frequently had surgery for non-functional benign neoplasms compared with older (55.7% vs 52.8% vs 45.9% vs 45.3%, for patients ≤60, 61 to 70, 71 to 80, and >80 years, respectively, P < .001), and less frequently had surgery for malignancy (8.8% vs 14.4% vs 22.5% vs 24.5%, P < .001). The median length of stay for patients ≤60 was 1 day compared with 2 days for patients 61-70, 71-80, and >80 (P < .001). The overall mortality rate was <1% and did not differ based on age (P = .18). Morbidity occurred less frequently in the younger age groups (7.3% vs 8.9% vs 11.2% vs 16.0%, P < .001) compared with older. Similar trends were seen for non-home discharge (1.4% vs 2.5% vs 4.8% vs 17.0%, P < .001). On multivariable analysis, patients aged >80 had a 2-fold increased likelihood of morbidity and a 9-fold increased likelihood of non-home discharge compared to patients aged ≤60.
Older age is associated with morbidity and non-home discharge after adrenalectomy. Knowledge of these risks is critical when counseling an aging surgical population.
肾上腺切除术的并发症发生率低，患者耐受性良好。但目前尚不清楚这些出色的结果是否在所有年龄段都一致。
使用了 2015 年至 2020 年美国外科医师学会国家手术质量改进计划数据集。根据年龄将接受肾上腺切除术的患者分为以下几组：≤60 岁、61-70 岁、71-80 岁和>80 岁。比较了不同年龄组患者的特征、手术指征、手术特点和术后结果。主要观察指标为死亡率、发病率、术后住院时间、非家庭出院和计划外再入院。进行了多变量逻辑回归分析。
共有 6114 名患者接受了肾上腺切除术。与年龄较大的患者相比，年轻患者更常因非功能性良性肿瘤而行手术治疗（55.7% vs 52.8% vs 45.9% vs 45.3%，分别为≤60 岁、61-70 岁、71-80 岁和>80 岁患者，P<0.001），而较少因恶性肿瘤而行手术治疗（8.8% vs 14.4% vs 22.5% vs 24.5%，P<0.001）。≤60 岁患者的中位住院时间为 1 天，而 61-70 岁、71-80 岁和>80 岁患者的中位住院时间为 2 天（P<0.001）。总体死亡率<1%，且与年龄无关（P=0.18）。年轻年龄组的发病率较低（7.3% vs 8.9% vs 11.2% vs 16.0%，P<0.001）。非家庭出院的趋势相似（1.4% vs 2.5% vs 4.8% vs 17.0%，P<0.001）。多变量分析显示，与≤60 岁的患者相比，年龄>80 岁的患者发生并发症的可能性增加了 2 倍，而非家庭出院的可能性增加了 9 倍。
年龄较大与肾上腺切除术后的发病率和非家庭出院相关。在为老年手术人群提供咨询时，了解这些风险至关重要。
