Context: Postoperative outcomes of patients with normotensive pheochromocytomas are poorly documented. Objective: We aimed to evaluate the impact of preoperative hypertension on postoperative outcomes following adrenalectomy for pheochromocytoma. Methods An international retrospective study of patients undergoing adrenalectomy for pheochromocytoma in 46 centers between 2012 and 2022 was performed. Hypertensive and normotensive pheochromocytoma were defined respectively by the presence or absence of hypertension history before or at the time of pheochromocytoma diagnosis. To evaluate differences in postoperative outcomes between hypertensive and normotensive patients, propensity score matched (PSM) analysis was performed. Results: Among 2016 patients with pheochromocytoma, 1034 (51.2%) had preoperative hypertension and 982 (49.8%) were normotensive. Hypertensive patients were 4.5 years older (P < .001), had a higher prevalence of type 2 diabetes (P < .001), had a higher median Charlson Comorbidity Index (2.0 vs 1.0; P < .001), and had an American Society of Anesthesiologists score of III to IV more frequently (41% vs 19.9%; P < .001) than normotensive patients. Nonadjusted analysis demonstrated that hypertensive patients had longer operative time (115.0 vs 103.5 minutes; P = .026), higher rate of vasopressors at skin closure (19.7% vs 15.4%; P = .013), more perioperative blood transfusions (7.7% vs 5.0%; P = .016), and an increased complication rate (21.6% vs 17.7%; P = .029). However, after 1:1 PSM, we found that readmission, complications, and serious complications were similar between cohorts. Conclusion: Patients with hypertensive pheochromocytomas have a higher risk of postoperative complications than normotensive patients due to the association of hypertension with a higher burden of comorbidities and older age. However, hypertension is not an independent risk factor of postoperative complications after pheochromocytoma surgery.
Araujo-Castro, M., Herrera, A., Wang, Y., Wang, Z., Śledziński, M., Hellmann, A., Raffaelli, M., Pennestrì, F., Sywak, M., Papachristos, A. J., Palazzo, F. F., Sung, T., Kim, B., Lee, Y., Eatock, F., Anderson, H., Iacobone, M., Daukša, A., Makay, O., Turk, Y., Basut Atalay, H., Nieveen Van Dijkum, E. J. M., Engelsman, A. F., Holscher, I., Materazzi, G., Rossi, L., Becucci, C., Shore, S. L., Fung, C., Waghorn, A., Mihai, R., Balasubramanian, S. P., Pannu, A., Tatarano, S., Velázquez-Fernández, D., Miller, J. A., Serrao-Brown, H., Chen, Y., Demarchi, M. S., Djafarrian, R., Doran, H., Wang, K., Stechman, M. J., Perry, H., Hubbard, J., Lamas, C., Mercer, P., Macpherson, J., Lumbiganon, S., Calatayud, M., Hanzu, F. A., Vidal, O., Minguez Ojeda, C., Papavramidis, T., Rodríguez De Vera Gómez, P., Aldrees, A., Altwjry, T., Valdés, N., Álvarez-Escola, C., García Sanz, I., Blanco Carrera, C., Manjón-Miguélez, L., De Miguel Novoa, P., Recasens, M., García Centeno, R., Robles Lázaro, C., Van Den Heede, K., Van Slycke, S., Michalopoulou, T., Aspinall, S., Melvin, R., Wen Liang Lau, J., Cheah, W. K., Hon Tang, M., Oh, H. B., Ayuk, J., Verhoeff, K., Sutcliffe, R. P., Parente, A., Postoperative outcomes in normotensive and hypertensive pheochromocytomas: an international study, <<THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM>>, 2025; (may 26): 1-11. [doi:10.1210/clinem/dgaf154] [https://hdl.handle.net/10807/322154]
Postoperative outcomes in normotensive and hypertensive pheochromocytomas: an international study
Raffaelli, Marco;Rossi, Leonardo;
2025
Abstract
Context: Postoperative outcomes of patients with normotensive pheochromocytomas are poorly documented. Objective: We aimed to evaluate the impact of preoperative hypertension on postoperative outcomes following adrenalectomy for pheochromocytoma. Methods An international retrospective study of patients undergoing adrenalectomy for pheochromocytoma in 46 centers between 2012 and 2022 was performed. Hypertensive and normotensive pheochromocytoma were defined respectively by the presence or absence of hypertension history before or at the time of pheochromocytoma diagnosis. To evaluate differences in postoperative outcomes between hypertensive and normotensive patients, propensity score matched (PSM) analysis was performed. Results: Among 2016 patients with pheochromocytoma, 1034 (51.2%) had preoperative hypertension and 982 (49.8%) were normotensive. Hypertensive patients were 4.5 years older (P < .001), had a higher prevalence of type 2 diabetes (P < .001), had a higher median Charlson Comorbidity Index (2.0 vs 1.0; P < .001), and had an American Society of Anesthesiologists score of III to IV more frequently (41% vs 19.9%; P < .001) than normotensive patients. Nonadjusted analysis demonstrated that hypertensive patients had longer operative time (115.0 vs 103.5 minutes; P = .026), higher rate of vasopressors at skin closure (19.7% vs 15.4%; P = .013), more perioperative blood transfusions (7.7% vs 5.0%; P = .016), and an increased complication rate (21.6% vs 17.7%; P = .029). However, after 1:1 PSM, we found that readmission, complications, and serious complications were similar between cohorts. Conclusion: Patients with hypertensive pheochromocytomas have a higher risk of postoperative complications than normotensive patients due to the association of hypertension with a higher burden of comorbidities and older age. However, hypertension is not an independent risk factor of postoperative complications after pheochromocytoma surgery.
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