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Risk Predictors of Prolonged Hypotension After Open Surgery for Pheochromocytomas and Paragangliomas

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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.

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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

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Acknowledgements

The authors gratefully acknowledge Ms. Xiao-Lu Nie (Centre for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China) for her assistance with statistical analysis.

Funding

None.

Author information

Author notes

  1. Hao Kong and Nan Li contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China

    Hao Kong

  2. Department of Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China

    Nan Li

  3. Department of Urology, Peking University First Hospital, Beijing, 100034, China

    Jie Tian

  4. Department of Biostatistics, Peking University First Hospital, Beijing, 100034, China

    Xue-Ying Li

Authors
  1. Hao Kong
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  2. Nan Li
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  3. Jie Tian
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  4. Xue-Ying Li
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Corresponding author

Correspondence to Hao Kong.

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Conflict of interest

The authors declare that they have no conflict of interests.

Consent to participate

Because of the retrospective and observational nature of the study, the local Ethics Committee agreed to exempt written informed consent.

Ethics approval

The original study protocol was approved by the Clinical Research Ethics Committee of Peking University First Hospital, Beijing, China (2019 [47]) on July 24, 2019.

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Kong, H., Li, N., Tian, J. et al. Risk Predictors of Prolonged Hypotension After Open Surgery for Pheochromocytomas and Paragangliomas. World J Surg 44, 3786–3794 (2020). https://doi.org/10.1007/s00268-020-05706-9

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  • DOI: https://doi.org/10.1007/s00268-020-05706-9

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