Introduction: Adrenalectomy for pheochromocytoma is considered to be a challenging procedure because of the risk of hemodynamic instability (HI), which is poorly defined and unpredictable. Our study aimed to determine the predictive factors for perioperative HI in patients undergoing unilateral adrenalectomy for pheochromocytoma. Methods: Between January 2005 and December 2021, 45 patients underwent unilateral adrenalectomy for pheochromocytoma in department of urology La Rabta Hospital. HI was defined as an occurrence of intraoperative episodes of systolic blood pressure above 200 mmHg, mean arteral pressure under 60 mmHg or vasoactive drug administration. Patients were divided into 2 groups depending on presence or absence of intraoperative HI. Patient demographics, tumor characteristics and perioperative hemodynamics were noted. A multivariable logistic regression analysis was performed to determine the independent preoperative risk factors for HI. Results: There was no postoperative mortality, and HI was noted 71.1% (32 patients). Open and laparoscopic adrenalectomy were performed in 36 and 9 patients respectively. Mean tumor size was 54.52 mm. Univariate analysis showed that gender, tumor size, tumoral necroses, B blockers treatment were significantly associated with Hi (p=0.019, p=0.00 01, p=0.0001, p=0.01, respectively). IH was correlated with Systolic blood pressure at incision, adrenal artery clamping and tumour removal (p=0.018, p=0.001, p=0.046, p=0.048, respectively). The multivariate logistic regression analysis showed that tumor size was an independent risk factors for intraoperative hemodynamic instability (OR 2.79, 95% CI: 1-61.8, P=0.008). Conclusions: Tumour size was the independant predictive factor with hemodynamic instability during adrenalectomy for pheochromocytoma. SOURCE OF Funding: I don't have any sources of findings
