Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma

Punam P. Parikh, Gustavo A. Rubio, Josefina C. Farra, John Lew

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Adrenal adenomas are benign tumors often discovered incidentally, and >70% are hormonally inactive. The remaining subset may produce excess aldosterone, cortisol, or catecholamine. Perioperative outcomes after adrenalectomy for such “hormonally active” tumors remain unclear. This study examines in-hospital outcomes after unilateral adrenalectomy for hormonally active tumors. Methods A retrospective review was performed using the Nationwide Inpatient Sample (2006-2011) to identify patients undergoing unilateral adrenalectomy for hormonally active or inactive tumors. Malignant adrenal tumors were excluded. Demographics, comorbidities, and postoperative complications were evaluated by univariate analysis, using two-tailed Chi-square and t-tests and multivariate logistic regression. Results Of 27,312 patients who underwent adrenalectomy, 78% (n = 21,279) had hormonally inactive and 22% (n = 6033) had hormonally active adrenal tumors. Among the latter, 65% (n = 4000) had primary hyperaldosteronism (Conn's syndrome), 33% (n = 1996) had hypercortisolism (Cushing's syndrome), and 1.4% (n = 85) had pheochromocytoma. Patients with pheochromocytoma had higher rate of comorbidities including congestive heart failure, chronic lung disease, and malignant hypertension compared with remaining hormonally active tumors (12% versus 4%, 18% versus 11%, 6% versus 2%; P < 0.01). For patients with pheochromocytoma versus other hormonally active tumors, mean length of stay was 5 versus 3 d and total in-hospital cost was $50,000 versus $41,000 (P < 0.01). On multivariate analysis, pheochromocytoma had an independently higher risk for intraoperative blood transfusion (4.2, 95% confidence interval [CI] 2.4-7.2), postoperative cardiac (7.6, 95% CI 2.8-20.2), and respiratory (1.9, 95% CI 1.0-3.3) complications. Conclusions Patients with pheochromocytoma have high rates of preoperative comorbidities, postoperative cardiopulmonary complications, and longer and more costly hospitalizations. Such high-risk patients should undergo appropriate preoperative medical optimization in preparation for adrenalectomy.

Original languageEnglish (US)
Pages (from-to)204-210
Number of pages7
JournalJournal of Surgical Research
Volume215
DOIs
StatePublished - Jul 1 2017

Fingerprint

Glandular and Epithelial Neoplasms
Pheochromocytoma
Adrenalectomy
Morbidity
Comorbidity
Neoplasms
Hyperaldosteronism
Cushing Syndrome
Confidence Intervals
Malignant Hypertension
Hospital Costs
Chi-Square Distribution
Aldosterone
Blood Transfusion
Adenoma
Lung Diseases
Catecholamines
Hydrocortisone
Inpatients
Length of Stay

Keywords

  • Adrenal adenoma
  • Adrenalectomy
  • Clinical outcomes
  • Pheochromocytoma

ASJC Scopus subject areas

  • Surgery

Cite this

Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma. / Parikh, Punam P.; Rubio, Gustavo A.; Farra, Josefina C.; Lew, John.

In: Journal of Surgical Research, Vol. 215, 01.07.2017, p. 204-210.

Research output: Contribution to journalArticle

Parikh, Punam P. ; Rubio, Gustavo A. ; Farra, Josefina C. ; Lew, John. / Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma. In: Journal of Surgical Research. 2017 ; Vol. 215. pp. 204-210.
@article{16b4d146677242ebb34da6881dcf578d,
title = "Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma",
abstract = "Background Adrenal adenomas are benign tumors often discovered incidentally, and >70{\%} are hormonally inactive. The remaining subset may produce excess aldosterone, cortisol, or catecholamine. Perioperative outcomes after adrenalectomy for such “hormonally active” tumors remain unclear. This study examines in-hospital outcomes after unilateral adrenalectomy for hormonally active tumors. Methods A retrospective review was performed using the Nationwide Inpatient Sample (2006-2011) to identify patients undergoing unilateral adrenalectomy for hormonally active or inactive tumors. Malignant adrenal tumors were excluded. Demographics, comorbidities, and postoperative complications were evaluated by univariate analysis, using two-tailed Chi-square and t-tests and multivariate logistic regression. Results Of 27,312 patients who underwent adrenalectomy, 78{\%} (n = 21,279) had hormonally inactive and 22{\%} (n = 6033) had hormonally active adrenal tumors. Among the latter, 65{\%} (n = 4000) had primary hyperaldosteronism (Conn's syndrome), 33{\%} (n = 1996) had hypercortisolism (Cushing's syndrome), and 1.4{\%} (n = 85) had pheochromocytoma. Patients with pheochromocytoma had higher rate of comorbidities including congestive heart failure, chronic lung disease, and malignant hypertension compared with remaining hormonally active tumors (12{\%} versus 4{\%}, 18{\%} versus 11{\%}, 6{\%} versus 2{\%}; P < 0.01). For patients with pheochromocytoma versus other hormonally active tumors, mean length of stay was 5 versus 3 d and total in-hospital cost was $50,000 versus $41,000 (P < 0.01). On multivariate analysis, pheochromocytoma had an independently higher risk for intraoperative blood transfusion (4.2, 95{\%} confidence interval [CI] 2.4-7.2), postoperative cardiac (7.6, 95{\%} CI 2.8-20.2), and respiratory (1.9, 95{\%} CI 1.0-3.3) complications. Conclusions Patients with pheochromocytoma have high rates of preoperative comorbidities, postoperative cardiopulmonary complications, and longer and more costly hospitalizations. Such high-risk patients should undergo appropriate preoperative medical optimization in preparation for adrenalectomy.",
keywords = "Adrenal adenoma, Adrenalectomy, Clinical outcomes, Pheochromocytoma",
author = "Parikh, {Punam P.} and Rubio, {Gustavo A.} and Farra, {Josefina C.} and John Lew",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.jss.2017.04.011",
language = "English (US)",
volume = "215",
pages = "204--210",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma

AU - Parikh, Punam P.

AU - Rubio, Gustavo A.

AU - Farra, Josefina C.

AU - Lew, John

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background Adrenal adenomas are benign tumors often discovered incidentally, and >70% are hormonally inactive. The remaining subset may produce excess aldosterone, cortisol, or catecholamine. Perioperative outcomes after adrenalectomy for such “hormonally active” tumors remain unclear. This study examines in-hospital outcomes after unilateral adrenalectomy for hormonally active tumors. Methods A retrospective review was performed using the Nationwide Inpatient Sample (2006-2011) to identify patients undergoing unilateral adrenalectomy for hormonally active or inactive tumors. Malignant adrenal tumors were excluded. Demographics, comorbidities, and postoperative complications were evaluated by univariate analysis, using two-tailed Chi-square and t-tests and multivariate logistic regression. Results Of 27,312 patients who underwent adrenalectomy, 78% (n = 21,279) had hormonally inactive and 22% (n = 6033) had hormonally active adrenal tumors. Among the latter, 65% (n = 4000) had primary hyperaldosteronism (Conn's syndrome), 33% (n = 1996) had hypercortisolism (Cushing's syndrome), and 1.4% (n = 85) had pheochromocytoma. Patients with pheochromocytoma had higher rate of comorbidities including congestive heart failure, chronic lung disease, and malignant hypertension compared with remaining hormonally active tumors (12% versus 4%, 18% versus 11%, 6% versus 2%; P < 0.01). For patients with pheochromocytoma versus other hormonally active tumors, mean length of stay was 5 versus 3 d and total in-hospital cost was $50,000 versus $41,000 (P < 0.01). On multivariate analysis, pheochromocytoma had an independently higher risk for intraoperative blood transfusion (4.2, 95% confidence interval [CI] 2.4-7.2), postoperative cardiac (7.6, 95% CI 2.8-20.2), and respiratory (1.9, 95% CI 1.0-3.3) complications. Conclusions Patients with pheochromocytoma have high rates of preoperative comorbidities, postoperative cardiopulmonary complications, and longer and more costly hospitalizations. Such high-risk patients should undergo appropriate preoperative medical optimization in preparation for adrenalectomy.

AB - Background Adrenal adenomas are benign tumors often discovered incidentally, and >70% are hormonally inactive. The remaining subset may produce excess aldosterone, cortisol, or catecholamine. Perioperative outcomes after adrenalectomy for such “hormonally active” tumors remain unclear. This study examines in-hospital outcomes after unilateral adrenalectomy for hormonally active tumors. Methods A retrospective review was performed using the Nationwide Inpatient Sample (2006-2011) to identify patients undergoing unilateral adrenalectomy for hormonally active or inactive tumors. Malignant adrenal tumors were excluded. Demographics, comorbidities, and postoperative complications were evaluated by univariate analysis, using two-tailed Chi-square and t-tests and multivariate logistic regression. Results Of 27,312 patients who underwent adrenalectomy, 78% (n = 21,279) had hormonally inactive and 22% (n = 6033) had hormonally active adrenal tumors. Among the latter, 65% (n = 4000) had primary hyperaldosteronism (Conn's syndrome), 33% (n = 1996) had hypercortisolism (Cushing's syndrome), and 1.4% (n = 85) had pheochromocytoma. Patients with pheochromocytoma had higher rate of comorbidities including congestive heart failure, chronic lung disease, and malignant hypertension compared with remaining hormonally active tumors (12% versus 4%, 18% versus 11%, 6% versus 2%; P < 0.01). For patients with pheochromocytoma versus other hormonally active tumors, mean length of stay was 5 versus 3 d and total in-hospital cost was $50,000 versus $41,000 (P < 0.01). On multivariate analysis, pheochromocytoma had an independently higher risk for intraoperative blood transfusion (4.2, 95% confidence interval [CI] 2.4-7.2), postoperative cardiac (7.6, 95% CI 2.8-20.2), and respiratory (1.9, 95% CI 1.0-3.3) complications. Conclusions Patients with pheochromocytoma have high rates of preoperative comorbidities, postoperative cardiopulmonary complications, and longer and more costly hospitalizations. Such high-risk patients should undergo appropriate preoperative medical optimization in preparation for adrenalectomy.

KW - Adrenal adenoma

KW - Adrenalectomy

KW - Clinical outcomes

KW - Pheochromocytoma

UR - http://www.scopus.com/inward/record.url?scp=85018782094&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018782094&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2017.04.011

DO - 10.1016/j.jss.2017.04.011

M3 - Article

C2 - 28688648

AN - SCOPUS:85018782094

VL - 215

SP - 204

EP - 210

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -