title: Adrenalectomy for adrenal-mediated hypertension: National Surgical Quality Improvement Program analysis of an institutional experience.
abstract: Adrenal-mediated hypertension (AMH) has been increasingly treated by laparoscopic adrenalectomy (LA). Metabolic derangements in patients with AMH could result in perioperative complications and mortality. Long-term operative and clinical outcomes after laparoscopic treatment of AMH have not been evaluated using large clinical databases. The institutional National Surgical Quality Improvement Program (NSQIP) data for patients undergoing adrenalectomy for AMH between 2002 and 2012 were reviewed. Patient demographics, perioperative variables, and outcomes were analyzed and compared with national NSQIP adrenalectomy data. Improvement in AMH was recorded when discontinuation or reduction of antihypertensive medication occurred or with a decrease of blood pressure on the preoperative antihypertensive regimen. Ninety-four patients underwent adrenalectomy. There were 48 patients with pheochromocytoma (PHE) and 46 patients with aldosterone-producing adenoma (APA). Eighty-five patients (90%) were taking antihypertensive medications preoperatively compared with 36 patients (38%) postoperatively (P < 0.0001). Patients with PHE were more likely to discontinue all medications compared with the patients with APA (80 vs 20%, respectively, P < 0.0001). Patients with PHE and APA, respectively, took an average of 2.0 and 3.2 antihypertensive medications preoperatively compared with 0.3 and 1.2 postoperatively. There were no conversions to open procedures or 30-day mortality. Our results were 0 per cent for cerebral vascular accident, 0 per cent for myocardial infarction, and 0.5 per cent for transfusions compared with the national NSQIP data of 0.2, 0, and 6.7 per cent, respectively. Patients presenting with significant AMH including PHE and APA can be effectively and safely treated with LA with minimal complications and with a significant number of patients eliminating or decreasing their need for antihypertensive medications.
authors.affiliation: Department of Surgery, Division of General Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Shada
authors.forename: Jayme B
authors.initials: JB
authors.lastname: Stokes
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.forename: Virginia B
authors.initials: VB
authors.lastname: Simpson
authors.forename: Shetal H
authors.initials: SH
authors.lastname: Padia
authors.forename: Robert M
authors.initials: RM
authors.lastname: Carey
authors.forename: John B
authors.initials: JB
authors.lastname: Hanks
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery*; D006973:Hypertension / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery*; D058996:Quality Improvement; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents