Postoperative Outcomes in Normotensive and Hypertensive Pheochromocytomas: An International Study.
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Araujo-Castro Marta, Herrera Aura, Wang Yanbo, Wang Zhicheng, Śledziński Maciej, Hellmann Andrzej, Raffaelli Marco, Pennestrì Francesco, Sywak Mark, Papachristos Alexander J, Palazzo Fausto F, Sung Tae-Yon, Kim Byung-Chang, Lee Yu-Mi, Eatock Fiona, Anderson Hannah, Iacobone Maurizio, Daukša Albertas, Makay Ozer, Turk Yigit, Basut Atalay Hafize, Nieveen van Dijkum Els J M, Engelsman Anton F, Holscher Isabelle, Materazzi Gabriele, Rossi Leonardo, Becucci Chiara, Shore Susannah L, Fung Clare, Waghorn Alison, Mihai Radu, Balasubramanian Sabapathy P, Pannu Arslan, Tatarano Shuichi, Velázquez-Fernández David, Miller Julie A, Serrao-Brown Hazel, Chen Yufei, Demarchi Marco Stefano, Djafarrian Reza, Doran Helen, Wang Kelvin, Stechman Michael J, Perry Helen, Hubbard Johnathan, Lamas Cristina, Mercer Philippa, MacPherson Janet, Lumbiganon Supanut, Calatayud María, Hanzu Felicia Alexandra, Vidal Oscar, Minguez Ojeda Cesar, Papavramidis Theodosios, Rodríguez de Vera Gómez Pablo, Aldrees Abdulaziz, Altwjry Tariq, Valdés Nuria, Álvarez-Escola Cristina, García Sanz Iñigo, Blanco Carrera Concepción, Manjón-Miguélez Laura, De Miguel Novoa Paz, Recasens Mónica, García Centeno Rogelio, Robles Lázaro Cristina, Van Den Heede Klaas, Van Slycke Sam, Michalopoulou Theodora, Aspinall Sebastian, Melvin Ross, Wen Liang Lau Joel, Cheah Wei Keat, Hon Tang Man, Oh Han Boon, Ayuk John, Verhoeff Kevin, Sutcliffe Robert P, Parente Alessandro
Аннотация
OBJECTIVE: We aimed to evaluate the impact of preoperative hypertension on postoperative outcomes following adrenalectomy for pheochromocytoma.
METHODS: An international retrospective study of patients undergoing adrenalectomy for pheochromocytoma in 46 centers between 2012 and 2022 was performed. Hypertensive and normotensive pheochromocytoma were defined respectively by the presence or absence of hypertension history before or at the time of pheochromocytoma diagnosis. To evaluate differences in postoperative outcomes between hypertensive and normotensive patients, propensity score matched (PSM) analysis was performed.
RESULTS: Among 2016 patients with pheochromocytoma, 1034 (51.2%) had preoperative hypertension and 982 (49.8%) were normotensive. Hypertensive patients were 4.5 years older (P < .001), had a higher prevalence of type 2 diabetes (P < .001), had a higher median Charlson Comorbidity Index (2.0 vs 1.0; P < .001), and had an American Society of Anesthesiologists score of III to IV more frequently (41% vs 19.9%; P < .001) than normotensive patients. Nonadjusted analysis demonstrated that hypertensive patients had longer operative time (115.0 vs 103.5 minutes; P = .026), higher rate of vasopressors at skin closure (19.7% vs 15.4%; P = .013), more perioperative blood transfusions (7.7% vs 5.0%; P = .016), and an increased complication rate (21.6% vs 17.7%; P = .029). However, after 1:1 PSM, we found that readmission, complications, and serious complications were similar between cohorts.
CONCLUSION: Patients with hypertensive pheochromocytomas have a higher risk of postoperative complications than normotensive patients due to the association of hypertension with a higher burden of comorbidities and older age. However, hypertension is not an independent risk factor of postoperative complications after pheochromocytoma surgery.