Catecholamine-induced hypertensive crisis during laparoscopic adrenalectomy for pheochromocytoma

A catecholamine-induced hypertensive crisis in patients with pheochromocytoma has recently been defined as systolic/diastolic blood pressure ≥ 180/120 mmHg. However, the consequences of observing blood pressure values above these thresholds during laparoscopic adrenalectomy have never been evaluated. The aim of this study was to identify factors associated with intraoperative catecholamine-induced hypertensive crisis (main objective) and postoperative cardiovascular complications (secondary objective). A multi-institutional retrospective cohort study from 01/01/2000 to 12/31/2016 was performed in eight university hospitals to identify independent factors associated with catecholamine-induced hypertensive crisis while adjusting for the clustering of patients within hospitals (generalized linear mixed model for hierarchical analysis). Logistic regression analysis was used to analyze postoperative cardiovascular complications on day 30. A total of 1056 patients underwent adrenalectomy for pheochromocytoma, of whom 894 were included in the final analysis. During adrenalectomy, 122 patients (13.6%) presented with at least one episode of a catecholamine-induced hypertensive crisis. Cardiovascular complications were observed in 32 patients (3.6%) on the 30th postoperative day. Tumor diameter (OR 1.011, 95%CI 1.001-1.021; p = 0.035) and any biological profile with high adrenaline (OR 1.602, 95%CI 1.051-2.441; p = 0.028) were significantly associated with the occurrence of intraoperative catecholamine-induced hypertensive crisis. The occurrence of intraoperative catecholamine-induced hypertensive crisis (OR 2.4, 95%CI 1.603-3.707; p = 0.033) remained significantly associated with cardiovascular complications at 30 days postoperatively. Catecholamine-induced hypertensive crisis is a relevant criterion for evaluation during laparoscopic adrenalectomy for pheochromocytoma because it is associated with an increased incidence of postoperative cardiovascular complications.