caa a22 4500 477035531 CHVBK 20180405111304.0 cr unu---uuuuu 170330e19960301xx s 000 0 eng 10.1007/s002689900060 doi (NATIONALLICENCE)springer-10.1007/s002689900060 Adrenal Surgery in the Elderly: Too Risky? [Elektronische Daten] [Chung Yau Lo, Jon A. van Heerden, Clive S. Grant, Jon Arne Söreide, Mark A. Warner, Duane M. Ilstrup] Abstract. Surgical treatment for adrenal disease may be withheld from elderly patients because of concern about prohibitive operative morbidity and mortality. To obtain objective data in our practice, we analyzed the results of adrenalectomy for patients aged 65 years and older. From 1984 to 1993 there were 85 patients (41 men, 44 women) with ages ranging from 65 to 84 years (median 69 years) who underwent adrenalectomy for Cushing syndrome (: n = 19), pheochromocytoma ( n = 16), adrenocortical carcinoma ( n = 7), benign adenoma ( n = 26), or primary hyperaldosteronism ( n = 17) at our institution. Median follow-up was 26 months (range 1 month to 9.1 years). A retrospective review with respect to preoperative risks and postoperative morbidity and mortality was performed utilizing the American Society of Anesthesiologists (ASA) physical status classification and the modified Goldman multifactorial cardiac risk scheme. Survival was estimated by the Kaplan-Meier methods. Operative mortality was 7% (six patients). No patients with pheochromocytoma or primary hyperaldosteronism died during the postoperative period. Patients undergoing adrenalectomy for adrenocortical carcinoma had a significantly higher operative mortality (43%) ( p = 0.006). Postoperative complications developed in 19 patients (22%), and there was a reoperation rate of 6% (5 patients). Nineteen percent of patients required postoperative intensive care admission and had a median stay of 2 days (range, 1-38 days). Median hospital stay was 7 days (range 3-47 days). Seventy-three patients (86%) remained alive at study completion. Two- and five-year survivals were 86% and 84%, respectively. Goldman class II or greater was an excellent predictor of increased morbidity ( p = 0.032) and mortality ( p = 0.036). With the exception of adrenocortical carcinoma, adrenal surgery for elderly patients can be performed with acceptable morbidity and mortality. The Goldman multifactorial cardiac risk scheme reliably predicts postoperative outcome in this elderly group of patients. 1996 by the Société Internationale de Chir, ugie Lo Chung Yau Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut van Heerden Jon A. Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut Grant Clive S. Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut Söreide Jon Arne Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut Warner Mark A. Department of Anesthesiology, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut Ilstrup Duane M. Section of Biostatistics, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut https://doi.org/10.1007/s002689900060 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900060 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lo Chung Yau Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut NATIONALLICENCE 700 1- van Heerden Jon A. Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut NATIONALLICENCE 700 1- Grant Clive S. Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut NATIONALLICENCE 700 1- Söreide Jon Arne Department Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut NATIONALLICENCE 700 1- Warner Mark A. Department of Anesthesiology, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut NATIONALLICENCE 700 1- Ilstrup Duane M. Section of Biostatistics, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, Minnesota 55905, U.S.A., US aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer