Risk Predictors of Prolonged Hypotension After Open Surgery for Pheochromocytomas and Paragangliomas
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ORIGINAL SCIENTIFIC REPORT
Risk Predictors of Prolonged Hypotension After Open Surgery for Pheochromocytomas and Paragangliomas Hao Kong1 • Nan Li2 • Jie Tian3 • Xue-Ying Li4
Accepted: 13 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Prolonged hypotension is a common complication after surgery for pheochromocytomas and paragangliomas (PPGLs). It places patients at an increased risk of major morbidities and even death. The objective of the study was to investigate the risk predictors of prolonged hypotension in patients undergoing open surgery for PPGLs. Methods The present study adopted a retrospective, single-center design. Patients who underwent open surgery for PPGLs were enrolled from January 1, 2002, to December 31, 2018, at Peking University First Hospital. Perioperative variables were screened from patients’ electronic medical records. Prolonged hypotension was defined as hypotension that required continuous catecholamine support for at least 30 min to maintain a systolic blood pressure of [ 90 mmHg after surgery. Results A total of 162 patients were included in the study. Fifty-two patients (31.1%) had prolonged hypotension with a median vasopressor support duration of 14 h (IQR = 4–30 h). Body mass index\24 kg/m2 (OR = 3.015, 95% CI 1.217–7.467; P = 0.017), larger tumor size (OR = 1.146, 95% CI 1.014–1.295; P = 0.029), and higher plasma norepinephrine concentration (OR = 1.053, 95% CI 1.019–1.087; P = 0.002) were associated with prolonged hypotension. Patients with prolonged hypotension had a higher incidence of complication, were more frequently admitted to the intensive care unit, underwent mechanical ventilation for a longer duration, and had a longer postoperative hospital stay when compared to those without. Conclusion Body mass index \ 24 kg/m2, larger tumor size, and higher plasma norepinephrine concentration are independent risk predictors of prolonged hypotension in patients undergoing open surgery for PPGLs.
Hao Kong and Nan Li contributed equally to this work. & Hao Kong [email protected] 1
Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
2
Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China
3
Department of Urology, Peking University First Hospital, Beijing 100034, China
4
Department of Biostatistics, Peking University First Hospital, Beijing 100034, China
Abbreviations BMI Body mass index CI Confidence interval HR Heart rate ICU Intensive care unit MV Mechanical ventilation PPGLs Pheochromocytomas and paragangliomas SBP Systolic blood pressure
123
World J Surg
Introduction
Materials and methods
Surgical resection is the standard and only curative treatment for pheochromocytomas and paragangliomas (PPGLs). However, hemodynamic instability is a great challenge for anesthesiologists and surgeons during surgery. Intubation, handling, and accidental squeezing of the tumor can instantly evoke catecholamine release, which can lead to hypertensive crisis,
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