Impact of frailty on complications and length of stay after minimally invasive adrenalectomy surgery

Background: Adrenal disease requiring surgery incidence increases with age, and minimally invasive adrenalectomy procedures have improved the safety of adrenal surgery. This study evaluates the perioperative outcomes of elective adrenalectomies when performed in older patients and how frailty affects such outcomes. Methods: Patients undergoing elective minimally invasive adrenalectomy were identified using the American College of Surgeon's National Surgical Quality Improvement Program Participant Use Targeted File years 2005 to 2020. The surgical indication was categorized as a benign disease, an endocrine disorder, or a malignant disease. Frailty was defined using the 5 -item modified frailty index. Multivariable regressions were used to model the relationship of age and frailty with surgical outcomes. Results: In 8,693 minimally invasive adrenalectomy patients, 5,281 (61%) were female, 5,026 (58%) were White, and 1,924 (22%) were aged 65 years or older. Surgical indications were benign disease 5,487 (63%),endocrinopathy 2,850 (33%), and malignancy 356 (4%). Patients aged<65 years (compared to those aged >= 65) were more likely to have a 5-item modified frailty index<1/4>0 (26% vs 14%, respectively) and less likely to have a 5-item modified frailty index=>= 3 (2% vs 4%, respectively; P<.001). Outcomes: 30-daymortality 20 (0.2%), complications 459 (5%), return to operating room 73 (0.8%), and median length of stay 2 days. Thirty-day mortality was associated with a 5-item modified frailty index >= 3(P=.009) and endocrine disease (P<1/4>.005) but not with age. Complications were associated with a 5-item modified frailty index >= 2(<= P<.001) and malignant disease (P<1/4>.002), but not with age. Conclusion: Minimally invasive adrenalectomy has low 30-day mortality and complication rates that increase with frailty and not age. Frailty is a better predictor than the age of most adverse outcomes after elective minimally invasive adrenalectomy.