Risk Factors for Intraoperative Hypertension during the Surgery of Primary Hyperparathyroidism

Objective: To investigate the incidence and to identify risk factors for the occurrence of intraoperative hypertension (IOH) during the surgery of primary hyperparathyroidism (pHPT). Subjects and Methods: The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. The IOH was defined as an increase in systolic blood pressure ≥ 20% compared to baseline values which lasted for 15 minutes. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on American Society of Anesthesiologists - ASA classification), comorbidities, type and duration of surgery and duration of anesthesia on IOH occurrence. The investigated factors were obtained from patients’ medical history, anesthesia charts and the database of the daily practice. The logistic regression analysis was done to determine the predictors of IOH. Results: Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR 2.080, 95% CI 1.102-3.925, p=0.024) and age (OR 0.569, 95% CI 0.360-0.901, p=0.016). Conclusion: In this study, a high percentage (56%) of the patients developed IOH during surgery of pHPT which indicated that a special attention should be paid to these patients, especially to high risk groups: older and patients with a history of hypertension. Further, this study showed that advanced age and hypertension as a co-existing disease, prior to parathyroid surgery were the independent risk factors for the occurrence of intraoperative hypertension.


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