Hemodynamic Instability during Surgery for Pheochromocytoma: A Retrospective Cohort Analysis

Moritz Senne; Doerte Wichmann; Pascal Pindur; Christian Grasshoff; Sven Mueller

doi:10.3390/jcm11247471

Hemodynamic Instability during Surgery for Pheochromocytoma: A Retrospective Cohort Analysis

J Clin Med. 2022 Dec 16;11(24):7471. doi: 10.3390/jcm11247471.

Authors

Moritz Senne¹, Doerte Wichmann¹, Pascal Pindur¹, Christian Grasshoff², Sven Mueller^{1

3}

Affiliations

¹ Department for Visceral, General and Transplant Surgery, Tübingen University Hospital, 72076 Tübingen, Germany.
² Department of Anaesthesiology and Intensive Care Medicine, Tübingen University Hospital, 72076 Tübingen, Germany.
³ Department of General and Visceral Surgery, Helios Clinics Gifhorn, 38518 Gifhorn, Germany.

Abstract

Background: Perioperative hemodynamic instability is one of the most common adverse events in patients undergoing adrenalectomy for pheochromocytoma. The aim of this study was to analyze the impact of perioperative severe hemodynamic instability.

Methods: We present a retrospective, single-center analysis in a major tertiary hospital of all consecutive patients undergoing elective adrenalectomy from 2005 to 2019 for pheochromocytoma. Severe perioperative hypertension and hypotension were evaluated, defined as changes in blood pressure larger than 30% of the preoperative patient-specific mean arterial pressure (MAP).

Results: Unilateral adrenalectomy was performed in 67 patients. Intraoperative episodes of hemodynamic instability occurred in 97% of all patients (n = 65), severe hypertension occurred in 24 patients (36%), and severe hypotensive episodes occurred in 62 patients (93%). Patients with more than five severe hypotensive episodes (n = 29) received higher preoperative alpha-adrenergic blockades (phenoxybenzamine 51 ± 50 mg d^-1 vs. 29 ± 27 mg d^-1; p = 0.023) and had a longer mean ICU stay (39.6 ± 41.5 h vs. 20.6 ± 19.1 h, p = 0.015).

Conclusion: Intraoperative hypotensive, rather than hypertensive, episodes occurred during adrenalectomy. The occurrence of more than five hypotensive episodes correlated well with a significantly longer hospital stay and ICU time.

Keywords: adrenalectomy; hemodynamic instability; pheochromocytoma.

Grants and funding

This research received no external funding. This work was supported by the Clinic for Visceral, General, and Transplant Surgery, Tübingen University Hospital, Germany. The APC was partly funded by the Open Access Publishing Fund of the University of Tübingen.