Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population
Por:
Romero-Velez G., Laird A.M., Barajas M.E., Sierra-Salazar M., Herrera M.F., Libutti S.K., Parides M.K., Pereira X., McAuliffe J.C.
Publicada:
1 ene 2021
Categoría:
Surgery
Resumen:
Background: Outcomes after adrenalectomy in patients with primary aldosteronism (PA) are variable. The aldosteronoma resolution score (ARS) uses preoperative variables to calculate a score that identifies those patients that are more likely to have resolution of hypertension after adrenalectomy. We aim to determine the efficacy of adrenalectomy and whether the ARS accurately predicts clinical success in a Black and Hispanic population. Methods: We reviewed patients who underwent adrenalectomy for PA from 2004 to 2018 at two academic centers treating primarily Hispanic and Black patients. Postoperative outcomes were evaluated based on the primary aldosteronism surgical outcome consensus criterion. Retrospectively, the accuracy of ARS was determined by a receiver operating characteristic curve and the area under the curve (AUC). Results: Forty-three Hispanic and 10 Black patients underwent adrenalectomy for PA. Twenty-two patients (41.5%) had complete clinical success. Variables associated with complete clinical success in the univariate analysis were female gender (p = 0.026), younger age (p = 0.001), lower preoperative aldosterone (p = 0.035), lower preoperative systolic blood pressure (p = 0.001), fewer number of preoperative antihypertensive medications (p = 0.007) and a higher ARS (p = 0.003). On multivariate analysis, only fewer number of preoperative antihypertensive medications was independently associated with complete clinical success (p = 0.026). The AUC of the ARS was 0.746. Conclusion: The rate of clinical success from adrenalectomy is good for Hispanic and Black patients with PA. Our analysis shows that the ARS is an accurate test of clinical success in Hispanic and Black patients. The ARS may be utilized preoperatively to frame expectations after adrenalectomy in these populations. © 2021, The Author(s).
Filiaciones:
Romero-Velez G.:
General Surgery, Department of Surgery, Montefiore Medical Center, The Bronx, NY, United States
Laird A.M.:
Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
Barajas M.E.:
Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
Sierra-Salazar M.:
Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
Herrera M.F.:
Division of Endocrine Surgery, Department of General Surgery, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
Libutti S.K.:
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
Parides M.K.:
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, The Bronx, NY, United States
Pereira X.:
General Surgery, Department of Surgery, Montefiore Medical Center, The Bronx, NY, United States
McAuliffe J.C.:
Surgical Oncology, Department of Surgery, Montefiore Medical Center, 1865 Eastchester Rd. Suite 2S7, Bronx, NY 10461, United States
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