Risk factors for postoperative hypotension after adrenalectomy for phaeochromocytoma: derivation of the PACS risk score.

Autor: Parente A; HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK., Thompson JP; HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK., Crook C; HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK., Bassett P; Statsconsultancy Limited, Amersham, UK., Aspinall S; Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK., Melvin R; Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK., Stechman MJ; Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK., Perry H; Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK., Balasubramanian SP; Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK., Pannu A; Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK., Palazzo FF; Department of Endocrine Surgery, Hammersmith Hospital, London, UK., Van Den Heede K; Department of Endocrine Surgery, Hammersmith Hospital, London, UK., Eatock F; Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK., Anderson H; Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK., Doran H; Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK., Wang K; Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK., Hubbard J; Department of Endocrine Surgery, St Thomas' Hospital, London, UK., Aldrees A; Department of Endocrine Surgery, St Thomas' Hospital, London, UK., Shore SL; Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK., Fung C; Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK., Waghorn A; Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK., Ayuk J; Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK., Bennett D; Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK., Sutcliffe RP; HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK. Electronic address: robert.sutcliffe@uhb.nhs.uk.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2023 Feb; Vol. 49 (2), pp. 497-504. Date of Electronic Publication: 2022 Oct 21.
DOI: 10.1016/j.ejso.2022.10.006
Abstrakt: Background: Due to the risk of postoperative hypotension (PH), invasive monitoring is recommended for patients who undergo adrenalectomy for phaeochromocytoma. Due to high costs and limited availability of intensive care, our aim was to identify patients at low risk of PH who may not require invasive monitoring.
Methods: Data for patients who underwent adrenalectomy for phaeochromocytoma between 2012 and 2020 were retrospectively collected by nine UK centres, including patient demographics, intraoperative and postoperative haemodynamic parameters. Independent risk factors for PH were analysed and used to develop a clinical risk score.
Results: PH developed in 118 of 430 (27.4%) patients. On univariable analysis, female sex (p = 0.007), tumour size (p < 0.001), preoperative catecholamine level (p < 0.001), open surgery (p < 0.001) and epidural analgesia (p = 0.006) were identified as risk factors for PH. On multivariable analysis, female sex (OR 1.85, CI 95% , 1.09-3.13, p = 0.02), preoperative catecholamine level (OR: 3.11, CI 95% , 1.74-5.55, p < 0.001), open surgery (OR: 3.31, CI 95% , 1.57-6.97, p = 0.002) and preoperative mean arterial blood pressure (OR: 0.59, CI 95% , 0.48-1.02, p = 0.08) were independently associated with PH, and were incorporated into a clinical risk score (AUROC 0.69, C-statistic 0.69). The risk of PH was 25% and 68% in low and high risk patients, respectively.
Conclusion: The derived risk score allows stratification of patients at risk of postoperative hypotension after adrenalectomy for phaeochromocytoma. Postoperatively, low risk patients may be managed on a surgical ward, whilst high risk patients should undergo invasive monitoring.
Competing Interests: Declaration of competing interest All authors declare that there are no conflict of interests.
(Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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