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

Abstract

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.

Risk Factors for Perioperative Hemodynamic Instability in Pheochromocytoma: A Systematic Review and Meta-Analysis

“…Sixty-seven additional articles were excluded after full-text evaluation. The remaining 14 articles were subjected to systematic review [ 4 , 5 , 6 , 7 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], and nine of those articles were meta-analyzed [ 4 , 6 , 7 , 17 , 19 , 21 , 22 , 23 , 24 ]. We detailed the study selection process in a flow chart ( Figure 1 ).…”

“…Surgical procedure (open surgery) [ 4 ], retroperitoneal approach [ 20 ], pre-operative beta blockade therapy [ 25 ], clinical symptoms [ 5 ], plasma epinephrine [ 7 ], plasma norepinephrine [ 7 ], plasma dopamine [ 7 ], plasma normetanephrine [ 25 ], urinary metanephrine and/or normetanephrine [ 5 ], familial disease [ 17 ], and the use of crystal/colloid fluid [ 23 ] were significantly associated with perioperative hemodynamic instability in one study each. Additionally, urinary epinephrine was evaluated in two studies.…”

“…Moreover, in adrenalectomy, a larger tumor size entails difficulty and increases the degree of manipulation necessary to remove the tumor, which can also cause hemodynamic instability during operation [ 8 ]. To date, several reports have evaluated the relationship between tumor size and hemodynamic instability [ 4 , 6 , 7 , 17 , 19 , 21 , 22 , 23 , 24 ]. Our meta-analysis confirms that larger tumor size could be a risk factor for such instability.…”

Predictors of prolonged hypotension requiring vasopressor support after resection of pheochromocytoma and paraganglioma

“…Much attention has been paid to intraoperative haemodynamic instability in patients with PCC/PGLs. [2][3][4][5] Only a few studies have focused on the predictors of postoperative hypotension that require continuous vasopressor support. Postoperative hypotension is associated with an increased risk of myocardial injury, acute kidney injury, stroke and even death.…”

Preoperative intravenous rehydration for patients with pheochromocytomas and paragangliomas: is it necessary? A propensity score matching analysis

“…Retrospective data have suggested that preoperative volume expansion achieved by saline infusion or increased water intake can reduce the risk of postural hypotension and perioperative hypotension by optimizing intravascular status [4][5][6][7]. Bai and colleagues [8] developed a nomogram for preoperative prediction of intraoperative hemodynamic instability (IHD) related to surgical treatment of pheochromocytoma. They found that an absence of preoperative volume expansion was an effective predictor for IHD involvement.…”