Risk factors and a predictive nomogram for hemodynamic instability during adrenalectomy for large pheochromocytomas and paragangliomas: A retrospective cohort study

This study aimed to investigate risk factors for intraoperative hemodynamic instability (HDI) and construct a clinical model for predicting intraoperative HDI for large pheochromocytomas and paragangliomas (PPGLs) patients.A single-center retrospective study of the clinicopathological data of patients undergoing surgery for PPGLs larger than 5 cm in diameter was conducted. A total of 215 eligible patients were enrolled in the study. Three advanced statistical methods were used to select independent risk factors in the training cohort for constructing a nomogram for predicting intraoperative HDI. The predictive performance of the model was assessed by area under the curve (AUC), positive predictive value (PPV), negative predictive value (NPV), and calibration. Decision curve analysis (DCA) and clinical impact curves (CIC) were used to assess predictive accuracy and clinical utility. The performance of the nomogram of was further internally validated.Comorbid diabetes mellitus, anemia, hypoproteinemia, 24-h urine vanillylmandelic acid and intraoperative blood transfusion (P < 0.05) were identified as independent risk factors for constructing the nomogram. In the training cohort, the AUC, PPV and NPV of the nomogram were 0.846, 91.6% and 69.2%. In the validation cohort, the AUC, PPV and NPV were 0.842, 91.8% and 63.3%. These showed good predictive power of the model. The calibration curves demonstrated an optimal consistency between the nomogram-predicted and the actual observed survival probability. DCA and CIC examination showed superior clinical relevance.The nomogram can objectively and accurately predict intraoperative HDI in patients with large PPGLs, which can help in individualized pre-treatment decision-making.