title: Preoperative risk factors of hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma.
abstract: Adrenalectomy for pheochromocytoma is considered to be a challenging procedure because of the risk of hemodynamic instability (HI), which is poorly defined and unpredictable. The objective of this retrospective study from a prospectively maintained database was to determine the predictive factors for perioperative HI, which is defined as a morbidity-related variable, in patients undergoing unilateral laparoscopic adrenalectomy (LA) for pheochromocytoma.
  
  
  
  A total of 149 patients with unilateral pheochromocytoma undergoing LA were included. First, HI was defined using independent hemodynamic variables associated with perioperative morbidity. Next, a multivariable logistic regression analysis was performed to determine the independent preoperative risk factors for HI.
  
  
  
  There was no postoperative mortality, and the overall morbidity rate was 10.7 %. The use of a cumulative dose of norepinephrine >5 mg was the only independent hemodynamic predictive factor for postoperative complications; thus, this variable was used to define HI. A multivariate analysis revealed that a symptomatic high preoperative blood pressure (p = 0.003) and a ten-fold increase in urinary metanephrine and/or normetanephrine levels (p < 0.0001) were significant predictors of HI. When no predictive factors were present, the risk of HI and the postoperative morbidity were 1.5 and 4.3 %, respectively. However, when two predictive factors were present, the HI risk and the postoperative morbidity were 53.8 and 30.8 %, respectively.
  
  
  
  Perioperative HI, defined as the need for a cumulative dose of norepinephrine >5 mg, is significantly associated with postoperative morbidity and can be predicted by symptomatic preoperative high blood pressure and above a ten-fold increase in urinary metanephrine and/or normetanephrine levels.
authors.affiliation: Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.|Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.|INSERM Unité1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.affiliation: Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bonnet
authors.affiliation: Department of Anesthesiology and Critical Care, Cochin Hospital, APHP, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Lentschener
authors.affiliation: Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thillois
authors.affiliation: Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.|Department of Cardiology, Cochin Hospital, APHP, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Duboc
authors.affiliation: Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.|INSERM Unité1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France.|Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Cochin Hospital, APHP, 75014, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.affiliation: Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France.|Department of Anesthesiology and Critical Care, Cochin Hospital, APHP, Paris, France.
authors.forename: Charles Marc
authors.initials: CM
authors.lastname: Samama
authors.affiliation: Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Université Paris Descartes, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. bertrand.dousset@aphp.fr.|Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France. bertrand.dousset@aphp.fr.|INSERM Unité1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France. bertrand.dousset@aphp.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods; D000328:Adult; D015415:Biomarkers; D016208:Databases, Factual; D005260:Female; D005602:France; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Hemodynamic instability; High blood pressure; Laparoscopic adrenalectomy; Morbidity; Norepinephrine; Pheochromocytoma