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Surgery. 2019 Jul;166(1):61-68. doi: 10.1016/j.surg.2019.01.031. Epub 2019 May 1.

Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators' consensus criteria within a worldwide cohort of patients.

Author information

1
Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, the Netherlands.
2
Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands.
3
Department of Endocrine Oncology, University Medical Center Utrecht, the Netherlands.
4
Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, the Netherlands. Electronic address: mvriens@umcutrecht.nl.
5
Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, NY, USA.
6
Department of Surgery, University of California San Francisco, USA; Department of Surgery, Boston University School of Medicine and Department of Graduate Medical Sciences, MA, USA.
7
Department of Surgery, University of California San Francisco, USA.
8
Department of Surgery, Boston University School of Medicine and Department of Graduate Medical Sciences, MA, USA.
9
Department of Endocrine Surgery, New York-Presbyterian-Columbia University, USA.
10
Department of Surgery, University of Chicago Medical Center, IL, USA.
11
Department of Endocrine Surgery, Baylor St. Luke's Medical Center, Houston, TX, USA.
12
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
13
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
14
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
15
Department of Surgery, University Health Network-Toronto General Hospital, ON, Canada.
16
Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia.
17
Department of Endocrine and Metabolic Surgery, Policlinico Universitario ''A Gemelli''-Università Cattolica del Sacro Cuore, Rome, Italy.
18
Department of Surgery, Maastricht University Medical Center+, the Netherlands.
19
Department of Surgery, VU Medical Center, Amsterdam, the Netherlands.
20
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
21
Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.

Abstract

BACKGROUND:

In a first step toward standardization, the Primary Aldosteronism Surgical Outcomes investigators introduced consensus criteria defining the clinical outcomes after adrenalectomy for primary aldosteronism. Within this retrospective cohort study, we evaluated the use of these consensus criteria in daily clinical practice in 16 centers in Europe, Canada, Australia, and the United States.

METHODS:

Patients who underwent unilateral adrenalectomy for primary aldosteronism between 2010 and 2016 were included. Patients with missing data regarding preoperative or postoperative blood pressure or their defined daily dose were excluded. According to the Primary Aldosteronism Surgical Outcomes criteria, patients were classified as complete, partial, or absent clinical success.

RESULTS:

A total of 380 patients were eligible for analysis. Complete, partial, and absent clinical success was achieved in 30%, 48%, and 22%, respectively. Evaluation of the Primary Aldosteronism Surgical Outcomes criteria showed that in 11% and 47% of patients with partial and absent clinical success, this classification was incorrect or debatable (16% of the total cohort). This concept of a "debatable classification of success" was due mainly to the cutoff of ≥20 mmHg used to indicate a clinically relevant change in systolic blood pressure and the use of percentages instead of absolute values to indicate a change in defined daily dose.

CONCLUSION:

Although introduction of the Primary Aldosteronism Surgical Outcomes consensus criteria induced substantial advancement in the standardization of postoperative outcomes, our study suggests that there is room for improvement in the concept for success given the observed limitations when the criteria were tested within our international cohort. In line, determining clinical success remains challenging, especially in patients with opposing change in blood pressure and defined daily dose.

PMID:
31053245
DOI:
10.1016/j.surg.2019.01.031

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