Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients

Jiang, Minchun; Ding, Huanyu; Li, Ying; Tang, Jian; Xiang, Kexu; Guo, Ying; Zhang, Shaoling

doi:10.1111/cen.13544

Cited by 28 publications

(44 citation statements)

References 38 publications

(52 reference statements)

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“…As confirmed in previous studies, this criteria are closely related to severe morbidity, especially cardiovascular morbidity [9,11]. In this study, 26.1% and 27.7% of patients in the development and validation cohorts, respectively, had IHD, which is consistent with a previous retrospective study that reported an incidence of IHD of 32.8% (44/134) in Chinese patients [4]. This nomogram incorporates four predictors based on extensive clinicopathological data, which were BMI, CHD, tumor size, and preoperative use of crystal/colloid fluid, for prediction of IHD.…”

Section: Fig 2 Nomogram To Predict Ihd In Patients With Pheochromocysupporting

confidence: 92%

“…due to excessive release of catecholamines into the circulation, which may result in life-threatening situations [4,5]. Mortality rate of pheochromocytomas has been reported can be as high as 50%; however, through widespread improvements in preoperative medical preparation [PMP], anesthesia strategy and surgical techniques, it has been significantly reduced to 0-2.9% [3].…”

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confidence: 99%

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Development and validation of a clinical model to predict intraoperative hemodynamic instability in patients with pheochromocytomas surgery

Bai

Yao

et al. 2020

Endocr J

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Although currently the primary strategy for the treatment of pheochromocytomas is surgery, it is associated with a high risk of intraoperative hemodynamic instability (IHD), even with adequate preoperative medical preparation, which may result in life-threatening situations. The aim of this study was to develop and validate a nomogram for preoperative prediction of IHD related to pheochromocytoma surgery. The development cohort consisted of 283 patients with pheochromocytoma who underwent unilateral laparoscopic or open adrenaletomy at our center between January 1, 2007 and December 31, 2016. The clinicopathological characteristics of each patient were recorded. The least absolute shrinkage and selection operator binary logistic regression model was used for data dimension reduction and feature selection, while multivariable logistic regression analysis was used to develop the prediction model. An independent cohort consisting of 119 consecutive patients from January 1, 2017 to December 31, 2018 was used for validation. The performance of the prediction model was assessed in regards to discrimination, calibration, and clinical usefulness. The predictors of this model included body mass index, coronary heart disease, tumor size, and preoperative use of crystal/colloid fluid. For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic of 0.767 (95% CI, 0.667-0.857) and good calibration (unreliability test, p = 0.852; Hosmer-Lemeshow test, p = 0.9309). Decision curve analysis demonstrated that the model was clinically useful. This nomogram to facilitate preoperative individualized prediction of IHD in patients with pheochromocytoma may help to improve the perioperative strategy and treatment outcome.

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Section: Fig 2 Nomogram To Predict Ihd In Patients With Pheochromocysupporting

confidence: 92%

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confidence: 99%

Development and validation of a clinical model to predict intraoperative hemodynamic instability in patients with pheochromocytomas surgery

Bai

Yao

et al. 2020

Endocr J

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“…Although the mainstay strategy for treatment of pheochromocytomas, surgery is associated with a high risk of perioperative morbidity (4). It has been reported that mortality can be as high as 50%.…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting severe morbidity after pheochromocytoma surgery

Wang

Yao

et al. 2020

Endocrine Connections

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Purpose Although resection is the primary treatment strategy for pheochromocytoma, surgery is associated with a high risk of morbidity. At present, there is no nomogram for prediction of severe morbidity after pheochromocytoma surgery, thus the aim of the present study was to develop and validate a nomogram for prediction of severe morbidity after pheochromocytoma surgery. Methods The development cohort consisted of 262 patients who underwent unilateral laparoscopic or open pheochromocytoma surgery at our center between 1 January 2007 and 31 December 2016. The patients’ clinicopathological characters were recorded. The least absolute shrinkage and selection operator (LASSO) binary logistic regression model was used for data dimension reduction and feature selection, then multivariable logistic regression analysis was used to develop the predictive model. An independent validation cohort consisted of 128 consecutive patients from 1 January 2017 and 31 December 2018. The performance of the predictive model was assessed in regards to discrimination, calibration, and clinical usefulness. Results Predictors of this model included sex, BMI, coronary heart disease, arrhythmia, tumor size, intraoperative hemodynamic instability, and surgical duration. For the validation cohort, the model showed good discrimination with an AUROC of 0.818 (95% CI, 0.745, 0.891) and good calibration (Unreliability test, P = 0.440). Decision curve analysis demonstrated that the model was also clinically useful. Conclusions A nomogram was developed to facilitate the individualized prediction of severe morbidity after pheochromocytoma surgery and may help to improve the perioperative strategy and treatment outcome.

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“…Speculation on avoiding alpha-receptor pretreatment in certain groups of patients with PPGL has been raised [4,8,[16][17][18]. However, reliable predictors of hemodynamic instability are not well characterized [11,14,[19][20][21]. This study does not have power to examine risk factors for per-operative hemodynamic instability but favours high dose PBZ pretreatment for minimizing perioperative hemodynamic variability.…”

Section: Discussionmentioning

confidence: 93%

Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

Ugleholdt¹,

Rasmussen²,

Haderslev³

et al. 2020

Preprint

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Background. Alpha-receptor blockade is the mainstay in preoperative treatment of patients with pheochromocytoma and paraganglioma (PPGL). However, evidence regarding optimal dosage regimen is lacking. This study compares the per- and postoperative hemodynamics in patients pre-treated with a high or low dose of phenoxybenzamine. Methods. 30 consecutive patients with PPGL undergoing laparoscopic adrenalectomy were identified retrospectively. All were pretreated with phenoxybenzamine but at two separate endocrine departments aiming at different blood pressure target. End-dosage of phenoxybenzamine differed significantly between departments with 14 patients receiving a high dose regimen and 16 a low dose regimen. As a control group, we included 42 patients undergoing laparoscopic adrenalectomy for other reasons. Primary purpose was to compare per- and postoperative hemodynamics in the high and low dose groups. Secondly, to compare these endpoints to the control group. Results. Baseline characteristics did not differ between the phenoxybenzamine treated groups. The high dose group had less intra-operative systolic and diastolic blood pressure fluctuation (p = 0.03) and less periods with heart rate above 100 bpm (p = 0.04) as compared to the low dose group. Use of intravenous fluids were similar between the two groups. However, postoperatively, more intravenous fluids were administered in the high dose group. Overall, the control group was more hemodynamic stable as compared to either group treated for PPGL. Conclusions. High dose phenoxybenzamine improves per-operative hemodynamic stability but causes a higher postoperative requirement for intravenous fluids. Overall, PPGL surgery is related to greater hemodynamic instability compared to adrenalectomy for other reasons.

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Preoperative risk factors for haemodynamic instability during pheochromocytoma surgery in Chinese patients

Cited by 28 publications

References 38 publications

Development and validation of a clinical model to predict intraoperative hemodynamic instability in patients with pheochromocytomas surgery

Development and validation of a clinical model to predict intraoperative hemodynamic instability in patients with pheochromocytomas surgery

Nomogram for predicting severe morbidity after pheochromocytoma surgery

Effect of High or Low Dose Phenoxybenzamine on Per-Operative Hemodynamics in Pheochromocytoma

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