Post-operative haemodynamic instability after adrenalectomy for phaeochromocytoma: is routine intensive care admission necessary?

Joseph Thompson; Davinia Bennett; John Ayuk; Niki Karavitaki; Michael O; Weibke Arlt; Robert Sutcliffe

doi:10.1530/endoabs.59.P008

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Endocrine Abstracts (2018) 59 P008 | DOI: 10.1530/endoabs.59.P008

SFEBES2018 Poster Presentations Adrenal and steroids (38 abstracts)

Post-operative haemodynamic instability after adrenalectomy for phaeochromocytoma: is routine intensive care admission necessary?

Joseph Thompson ¹ , Davinia Bennett ² , John Ayuk ² , Niki Karavitaki ² , Michael O’Reilly ² , Weibke Arlt ² & Robert Sutcliffe ²

Err

Author affiliations

¹University of Birmingham, Birmingham, UK; ²University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

Introduction: UK guidelines state that all patients undergoing adrenalectomy for phaeochromocytoma must be admitted to intensive care post-operatively due to the risk of haemodynamic instability (HDI). Intensive care beds are a scarce resource and it is important to regularly evaluate the need for admission, preventing unnecessary admission.

Methods: The study population included all patients who underwent adrenalectomy for phaeochromocytoma at a UK tertiary centre between 2007 and 2017 (n=39). Based on the parameters quoted in the literature post-operative HDI was defined as: systolic blood pressure >200 mmHg or <90 mmHg and heart rate >120 bpm or <50 bpm (all within the first 24 hours post-operatively). Additionally, the need for vasopressors within the first 24 hours post-operatively was recorded. A number of pre-operative variables were analysed including: tumour characteristics, pre-operative blood pressure, plasma metanephrines, alpha and beta blockade and the presence of genetic syndromes. Intra-operative variables were also recorded. Data was retrospectively analysed from pre-operative assessment charts, anaesthetic charts, ITU charts, clinic letters, lab results and observations in Clinical Portal/PICS. Univariate analysis was performed using Fisher’s exact test and Kruskall Wallis to identify risk factors for post-operative HDI and post-operative vasopressor use.

Results: 19/39 patients (49%) experienced HDI with 11 of these patients requiring vasopressors within the first 24 hours post-operatively. Patients who underwent open surgery were significantly more likely to experience HDI than with laparoscopic surgery (76% vs 17%; P<0.001). Additionally, patients who had epidural anaesthesia were significantly more likely to experience HDI than patients who did not have epidural anaesthesia (69% vs. 32%; P=0.05). For tumours <4 cm (n=14) there was no HDI following laparoscopic surgery (laparoscopic 0% vs open surgery 50%; P=0.08).

Conclusion: Patients undergoing laparoscopic adrenalectomy with tumours <4 cm in diameter are less likely to experience post-operative haemodynamic instability and may not need routine intensive care admission.