Impact of Intraoperative Hemodynamic Fluctuation on Postoperative Complications in Patients With Pheochromocytoma and Paraganglioma Surgery

Abstract

Abstract Background To identify the effect of hemodynamic fluctuations on severe postoperative complications in patients undergoing surgery for pheochromocytoma and paraganglioma (PPGL). Methods Patients with PPGL confirmed by postoperative pathologic examination in Fujian Provincial Hospital from January 2015 to January 2021 were enrolled. Demographic characteristics, comorbidities, preoperative examinations, preoperative preparation, intraoperative data, and postoperative complications were collected. Receiver operating characteristic curve was used to calculate the cutoff point of intraoperative standard deviation of systolic blood pressure for prediction of severe postoperative complication. According to the cutoff point, patients were divided into fluctuation and nonsevere fluctuation groups. Incidence of postoperative complication, intensive care unit (ICU) admission, length of stay after the operation, and length of ICU stay between the 2 groups was compared. The cumulative incidence and hazard ratio of postoperative complications were evaluated by Kaplan�Meier method and Cox regression analysis. Results A total of 126 patients were included in the study with 41 and 85 cases in the severe fluctuation and nonsevere fluctuation groups, respectively. Compared with the nonsevere fluctuation group, the incidence of postoperative complications (58.5% vs. 16.5%, P < 0.001), ICU admission rate (26.8% vs. 10.6%, P = 0.019), postoperative hospital stay, and ICU stay (P < 0.05) were higher in the severe fluctuation group. The Kaplan–Meier curve showed a higher incidence of postoperative complications in patients with severe blood pressure fluctuations (P < 0.05). The Cox regression analysis also showed that patients in the severe fluctuation group were more susceptible to postoperative complications (hazard ratio = 3.010, 95% confidence interval 1.334–6.806). Conclusions For patients with PPGL, the intraoperative hemodynamic fluctuations are associated with an increased risk of severe postoperative complications.