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

Wessel M. C. M. Vorselaars, Dirk-Jan van Beek, Emily L. Postma, Wilko Spiering, Inne H. M. Borel Rinkes, Gerlof D. Valk, Menno R. Vriens, Rasa Zarnegar, Frederick T. Drake, Quan Y. Duh, Stephanie D. Talutis, David B. McAneny, Catherine McManus, James A. Lee, Scott B. Grant, Raymon H. Grogan, Minerva A. Romero Arenas, Nancy D. Perrier, Benjamin J. Peipert, Michael N. Mongelli & 16 others Tanya Castelino, Elliot J. Mitmaker, David N. Parente, Jesse D. Pasternak, Anton F. Engelsman, Mark Sywak, Gerardo D'Amato, Marco Raffaelli, Valerie Schuermans, Nicole D. Bouvy, Hasan H. Eker, H. Jaap Bonjer, Nina M. Vaarzon Morel, Els J. M. Nieveen van Dijkum, Madelon J. H. Metman, Schelto Kruijff

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
JournalSurgery (United States)
DOIs
Publication statusPublished - 2019

Cite this

Vorselaars, Wessel M. C. M. ; Beek, Dirk-Jan van ; Postma, Emily L. ; Spiering, Wilko ; Borel Rinkes, Inne H. M. ; Valk, Gerlof D. ; Vriens, Menno R. ; Zarnegar, Rasa ; Drake, Frederick T. ; Duh, Quan Y. ; Talutis, Stephanie D. ; McAneny, David B. ; McManus, Catherine ; Lee, James A. ; Grant, Scott B. ; Grogan, Raymon H. ; Romero Arenas, Minerva A. ; Perrier, Nancy D. ; Peipert, Benjamin J. ; Mongelli, Michael N. ; Castelino, Tanya ; Mitmaker, Elliot J. ; Parente, David N. ; Pasternak, Jesse D. ; Engelsman, Anton F. ; Sywak, Mark ; D'Amato, Gerardo ; Raffaelli, Marco ; Schuermans, Valerie ; Bouvy, Nicole D. ; Eker, Hasan H. ; Bonjer, H. Jaap ; Vaarzon Morel, Nina M. ; Nieveen van Dijkum, Els J. M. ; Metman, Madelon J. H. ; Kruijff, Schelto. / Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients. In: Surgery (United States). 2019.
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title = "Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients",
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.",
author = "Vorselaars, {Wessel M. C. M.} and Beek, {Dirk-Jan van} and Postma, {Emily L.} and Wilko Spiering and {Borel Rinkes}, {Inne H. M.} and Valk, {Gerlof D.} and Vriens, {Menno R.} and Rasa Zarnegar and Drake, {Frederick T.} and Duh, {Quan Y.} and Talutis, {Stephanie D.} and McAneny, {David B.} and Catherine McManus and Lee, {James A.} and Grant, {Scott B.} and Grogan, {Raymon H.} and {Romero Arenas}, {Minerva A.} and Perrier, {Nancy D.} and Peipert, {Benjamin J.} and Mongelli, {Michael N.} and Tanya Castelino and Mitmaker, {Elliot J.} and Parente, {David N.} and Pasternak, {Jesse D.} and Engelsman, {Anton F.} and Mark Sywak and Gerardo D'Amato and Marco Raffaelli and Valerie Schuermans and Bouvy, {Nicole D.} and Eker, {Hasan H.} and Bonjer, {H. Jaap} and {Vaarzon Morel}, {Nina M.} and {Nieveen van Dijkum}, {Els J. M.} and Metman, {Madelon J. H.} and Schelto Kruijff",
year = "2019",
doi = "10.1016/j.surg.2019.01.031",
language = "English",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",

}

Vorselaars, WMCM, Beek, D-JV, Postma, EL, Spiering, W, Borel Rinkes, IHM, Valk, GD, Vriens, MR, Zarnegar, R, Drake, FT, Duh, QY, Talutis, SD, McAneny, DB, McManus, C, Lee, JA, Grant, SB, Grogan, RH, Romero Arenas, MA, Perrier, ND, Peipert, BJ, Mongelli, MN, Castelino, T, Mitmaker, EJ, Parente, DN, Pasternak, JD, Engelsman, AF, Sywak, M, D'Amato, G, Raffaelli, M, Schuermans, V, Bouvy, ND, Eker, HH, Bonjer, HJ, Vaarzon Morel, NM, Nieveen van Dijkum, EJM, Metman, MJH & Kruijff, S 2019, 'Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients' Surgery (United States). https://doi.org/10.1016/j.surg.2019.01.031

Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients. / Vorselaars, Wessel M. C. M.; Beek, Dirk-Jan van; Postma, Emily L.; Spiering, Wilko; Borel Rinkes, Inne H. M.; Valk, Gerlof D.; Vriens, Menno R.; Zarnegar, Rasa; Drake, Frederick T.; Duh, Quan Y.; Talutis, Stephanie D.; McAneny, David B.; McManus, Catherine; Lee, James A.; Grant, Scott B.; Grogan, Raymon H.; Romero Arenas, Minerva A.; Perrier, Nancy D.; Peipert, Benjamin J.; Mongelli, Michael N.; Castelino, Tanya; Mitmaker, Elliot J.; Parente, David N.; Pasternak, Jesse D.; Engelsman, Anton F.; Sywak, Mark; D'Amato, Gerardo; Raffaelli, Marco; Schuermans, Valerie; Bouvy, Nicole D.; Eker, Hasan H.; Bonjer, H. Jaap; Vaarzon Morel, Nina M.; Nieveen van Dijkum, Els J. M.; Metman, Madelon J. H.; Kruijff, Schelto.

In: Surgery (United States), 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients

AU - Vorselaars, Wessel M. C. M.

AU - Beek, Dirk-Jan van

AU - Postma, Emily L.

AU - Spiering, Wilko

AU - Borel Rinkes, Inne H. M.

AU - Valk, Gerlof D.

AU - Vriens, Menno R.

AU - Zarnegar, Rasa

AU - Drake, Frederick T.

AU - Duh, Quan Y.

AU - Talutis, Stephanie D.

AU - McAneny, David B.

AU - McManus, Catherine

AU - Lee, James A.

AU - Grant, Scott B.

AU - Grogan, Raymon H.

AU - Romero Arenas, Minerva A.

AU - Perrier, Nancy D.

AU - Peipert, Benjamin J.

AU - Mongelli, Michael N.

AU - Castelino, Tanya

AU - Mitmaker, Elliot J.

AU - Parente, David N.

AU - Pasternak, Jesse D.

AU - Engelsman, Anton F.

AU - Sywak, Mark

AU - D'Amato, Gerardo

AU - Raffaelli, Marco

AU - Schuermans, Valerie

AU - Bouvy, Nicole D.

AU - Eker, Hasan H.

AU - Bonjer, H. Jaap

AU - Vaarzon Morel, Nina M.

AU - Nieveen van Dijkum, Els J. M.

AU - Metman, Madelon J. H.

AU - Kruijff, Schelto

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064933366&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31053245

U2 - 10.1016/j.surg.2019.01.031

DO - 10.1016/j.surg.2019.01.031

M3 - Article

JO - Surgery

JF - Surgery

SN - 0039-6060

ER -