Abstract
Background
Phenoxybenzamine has been the standard agent for blockade before adrenalectomy for
pheochromocytoma. However, high cost and limited availability have hampered its use.
This study investigated whether other agents have supplanted the use of phenoxybenzamine
as the first-line agent for alpha blockade in pheochromocytoma.
Methods
We performed a retrospective analysis of patients in the IBM MarketScan Database who
underwent adrenalectomy for pheochromocytoma (2008–2019). Patients were categorized
as having been blocked with phenoxybenzamine, selective alpha blockers, calcium channel
blockers and/or beta blockers, or none of the above. The outcomes included prescription
costs, perioperative costs, and length of stay.
Results
A total of 552 patients were identified; 58.7% were female, and the median age was
49 (interquartile range 40–57) years. In total, 291 (52.7%) patients were blocked
with phenoxybenzamine, 114 (20.7%) with selective alpha blockers, 42 (7.6%) with only
calcium channel blockers and/or beta blockers, and 76 (13.8%) with none. The proportion
of patients blocked with phenoxybenzamine decreased from 71.0% in 2008 to 21.2% in
2019. The proportion of patients blocked with selective alpha blockers increased from
6.5% in 2008 to 42.4% and in 2019. The median cost of phenoxybenzamine increased from
$722 (interquartile range $441–$1,514) in 2008 to $9,616 (interquartile range $5,049–$16,373)
in 2019 (P < .001). Length of stay (2 [interquartile range 1–4] days vs 2 [interquartile range
0–3] days) and total perioperative costs ($24,250 [interquartile range $17,462–$33,849]
vs $22,098 [interquartile range $16,341–$29,178] between phenoxybenzamine and selective
alpha blocker groups were similar.
Conclusion
There has been a significant shift away from phenoxybenzamine for preoperative blockade
before resection of pheochromocytoma. Selective alpha blockers and calcium channel
blockers are increasingly used, likely due to reduced costs, without compromised length
of stay or intensive care unit admission.
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Article info
Publication history
Published online: September 24, 2022
Accepted:
May 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
