Our Summary

This research paper looks at the impact of frailty on patients undergoing adrenalectomy (surgery to remove one or both adrenal glands, usually due to a tumor). The researchers used a 5-item frailty index (5-iFI) to measure frailty. They found that patients with higher frailty scores were more likely to experience complications after surgery and to use more healthcare resources. These resources included a longer hospital stay, the need for continued care after leaving the hospital, and returning to the hospital within 30 days of being discharged. As a result, they conclude that tools like the 5-iFI can be useful in determining the risks and benefits of surgery for frail patients, guiding discussions with patients about their care, and planning interventions to improve their health before surgery.

FAQs

  1. What is an adrenalectomy and why is it performed?
  2. What is the 5-item frailty index (5-iFI) and how does it impact the outcome of an adrenalectomy?
  3. How does a higher frailty score affect the use of healthcare resources post-surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about adrenalectomy is to discuss the potential impact of frailty on their surgery and recovery. It is important for patients to understand that being frail can increase the risk of complications and the need for additional healthcare resources. By assessing frailty before surgery, doctors can better tailor their treatment plan to optimize outcomes and minimize risks. Patients should be encouraged to discuss any concerns about frailty with their healthcare team and to work together on strategies to improve their health before undergoing adrenalectomy.

Suitable For

Patients who are typically recommended adrenalectomy include those with adrenal tumors (benign or malignant), adrenal hyperplasia, adrenal cancer, Cushing’s syndrome, Conn’s syndrome, pheochromocytoma, and adrenal metastases from other cancers. Adrenalectomy is often recommended when the tumor is causing hormonal imbalances, symptoms such as high blood pressure, or if there is suspicion of cancer. It is important for patients to undergo a thorough evaluation by a multidisciplinary team, including endocrinologists, surgeons, and radiologists, to determine if adrenalectomy is the best treatment option for them.

Timeline

Before adrenalectomy:

  1. Patient undergoes preoperative evaluation, including imaging studies and blood tests to confirm the need for surgery and assess overall health.
  2. Patient may meet with an endocrinologist to discuss the risks and benefits of surgery and potential outcomes.
  3. Patient may be advised to stop certain medications or make lifestyle modifications in preparation for surgery.
  4. Patient may undergo a preoperative assessment of frailty using tools like the 5-iFI to determine their risk for complications.

After adrenalectomy:

  1. Patient undergoes surgery to remove one or both adrenal glands.
  2. Patient is monitored closely in the recovery room for any immediate complications.
  3. Patient may experience pain and discomfort in the days following surgery, requiring pain management medications.
  4. Patient may need to stay in the hospital for a few days to monitor for any postoperative complications.
  5. Patient may require additional care and support after leaving the hospital, such as physical therapy or home health services.
  6. Patient may need to follow up with their healthcare team for monitoring of hormone levels and overall health post-surgery.
  7. Patient may need to return to the hospital within 30 days of discharge for any complications or concerns related to the surgery.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing adrenalectomy?
  2. How will my frailty level impact my recovery and outcomes after surgery?
  3. Are there any specific precautions or additional measures that should be taken for a frail patient undergoing adrenalectomy?
  4. What is the expected recovery time and rehabilitation process following adrenalectomy for a frail patient?
  5. Will I need additional support or care at home after the surgery, and if so, for how long?
  6. What are the signs and symptoms of complications that I should watch out for after the surgery?
  7. How will my frailty level impact my long-term prognosis and overall health following adrenalectomy?
  8. Are there any lifestyle changes or interventions that can help improve my health and reduce the risks associated with surgery?

Reference

Authors: Ravivarapu KT, Garden EB, Al-Alao O, Small AC, Palese MA. Journal: Am J Surg. 2022 Jun;223(6):1120-1125. doi: 10.1016/j.amjsurg.2021.11.020. Epub 2021 Nov 26. PMID: 34857360