Surgical Treatment of Adrenal Disease
Analysis of risk factors for intraoperative hemodynamic instability in adrenal incident pheochromocytoma
Jie Tian, Hao Kong, Nan Li, Lu Liu, Kai Wu, Bo Jin, Lei Zhang, Ying Gao, Dongxin Wang, Kan Gong, Liqun Zhou, Zheng Zhang, Junqing Zhang
Published 2019-04-15
Cite as Chin J Urol, 2019, 40(4): 262-266. DOI: 10.3760/cma.j.issn.1000-6702.2019.04.006
Abstract
ObjectiveTo evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma.
MethodsPerioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed. There were 39 males and 41 females, with mean age of 45.1 years (13-76 years old). The median tumor length was 5.1 cm (1.5-14.0 cm), with 25 cases (31.3%) on the left side , 55 cases (68.8%) on the right side. There were 37 cases combined with coronary heart disease or diabetes or BMI≥24 kg/m2. Patients were divided into hemodynamic instability (HI group) and hemodynamic stability group (HS group) by whether intraoperative hemodynamic instability occurred. The differences of demographic characteristics and clinical parameters between the two groups were compared. Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery.
ResultsThere were 54 cases (67.5%) in the HS group and 26 cases (32.5%) in the HI group. Univariate analysis showed that there was no significant difference in age [(44.06±13.58) years old vs. (47.35±16.11) years old], combined with coronary heart disease or diabetes or BMI≥24 kg/m2 [50.0% (27/54) vs. 38.5% (10/26)], tumor long diameter [median 5.0 cm(1.5-14.0 cm) vs. 6.0cm(1.5-13.5 cm)], tumor location[left: 29.6% (16/54) vs. 34.6% (9/26)], preoperative catecholamine test positive [44.4% (20/45) vs. 50.0% (10/20)], open surgery [27.8% (15/54) vs. 34.6% (9/26)]and preoperative non-alpha blockers[13.0%(7/54) vs. 30.8%(8/26)] between HS group and HI group (P>0.05). Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability. Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI (OR=4.574, 95%CI 1.273-16.432, P=0.020).
ConclusionsPreoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability. Therefore, it is recommended that patients with adrenal incidental tumors, especially those who fail to rule out pheochromocytoma, take preoperative alpha blockers.
Key words:
Pheochromocytoma; Adrenal incidentaloma; Hemodynamic; Alpha blocker
Contributor Information
Jie Tian
Department of Urology, Peking University First Hospital, Beijing 100034, China
Hao Kong
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
Nan Li
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
Lu Liu
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
Kai Wu
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
Bo Jin
Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
Lei Zhang
Department of Urology, Peking University First Hospital, Beijing 100034, China
Ying Gao
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
Dongxin Wang
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
Kan Gong
Department of Urology, Peking University First Hospital, Beijing 100034, China
Liqun Zhou
Department of Urology, Peking University First Hospital, Beijing 100034, China
Zheng Zhang
Department of Urology, Peking University First Hospital, Beijing 100034, China
Junqing Zhang
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
