Associated factors of intraoperative hemodynamic instability in patients with incidental pheochromocytomas

Abstract

Objective: To analyze the associated factors of intraoperative hemodynamic instability (HI) in patients with incidental pheochromocytomas. Methods: The data of 104 patients with a pathological diagnosis of pheochromocytoma at Chinese PLA General Hospital between January 2011 and December 2016 was retrospectively analyzed. The patients were divided into hemodynamic stability (HS) group (n=56) and HI group (n=48) according to hemodynamic characteristics. The clinical features, biochemical test, preoperative and intraoperative hemodynamics were analyzed. Multivariate logistic regression analysis was used to explore the associated factors of HI. Results: The age [(44.7±12.7) years vs (52.1±12.8) years], tumor diameter [(47.9±16.3) mm vs (57.9±21.6) mm], preoperative blood pressure [(121.3±11.5) mmHg vs (127.2±13.3) mmHg] in HS group were less than those in HI group (all P<0.05). The proportion of age ≥ 50 years (28.6% vs 64.6%), tumor diameter ≥ 45 mm (48.2% vs 68.8%) and hematocrit < 0.38 (25.0% vs 51.3%) in HS group were less than that in HI group (all P<0.05). Multivariate logistic regression analysis indicated that age ≥ 50 years (OR=7.940, 95% CI: 2.480-25.417, P<0.001), tumor diameter ≥ 45 mm (OR=5.042, 95% CI: 1.482-17.156, P=0.010), blood pressure ≥ 130/80 mmHg (OR=3.127, 95% CI: 1.034-9.463, P=0.044) and hematocrit < 0.38 (OR=6.273, 95% CI: 1.893-20.788, P=0.003) were independent associated factors of HI. The proportion of HI ( χ(2)=9.033, P=0.003) and intensive care unit (ICU) admission ( χ(2)=16.641, P<0.001) increased along with increasing associated factors. Conclusion: Adequate preoperative medical preparation and volume expansion for appropriate blood pressure are important for elder patients with large tumor to prevent HI in patients with incidental pheochromocytomas.