Abstract
Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA.
Highlights
Recent surveys showed a higher trend of performance toward general surgeons, minimally‐invasive adrenalectomy (MIA) remains a procedure of interest to urologists [1,2,3,4]
A total of 90 consecutive patients with a confirmed diagnosis of unilateral primary aldosteronism (UPA) were identified among centers
According to Primary Aldosteronism Surgical Outcomes (PASO) criteria, the standardized composite outcome of adrenalectomy for UPA is represented by the concurrent attainment of normalization of blood pressure without the aid of antihypertensive medication and the absence of hypokalemia [8]
Summary
Recent surveys showed a higher trend of performance toward general surgeons, minimally‐invasive adrenalectomy (MIA) remains a procedure of interest to urologists [1,2,3,4]. In analogy to other major urological procedures, the concept of “trifecta” for standardizing adrenalectomy results in a single scoring system would represent a convenient tool to describe and predict main outcomes as to increase reproducibility between series [13,14,15]. In this scenario, we sought to develop a novel scoring system for standardizing UPA surgical management and to assess its ability to predict clinical, biochemical, and combined success at an extended follow‐up on a multi‐institutional, minimally‐invasive, adrenalectomy dataset.
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