{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T19:09:42Z","timestamp":1778872182127,"version":"3.51.4"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K08 CA270385"],"award-info":[{"award-number":["K08 CA270385"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alpha-blockade is utilized in the preoperative preparation of patients with pheochromocytomas. Both selective and nonselective alpha-blockade are safe with equivalent clinical outcomes; the goal of this study was to evaluate the comparative costs of selective and nonselective alpha-blockade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study (2004\u20132022) of patients who underwent adrenalectomy for pheochromocytoma with preoperative alpha-blockade from Optum\u2019s deidentified Clinformatics\u00ae Data Mart Database. Patients were stratified by treatment with selective (prazosin, doxazosin, terazosin) or nonselective (phenoxybenzamine) alpha-blockade. Primary outcomes were: (1) costs of alpha-blockade in the 30 days prior to surgery (AB) and (2) adjusted standard costs from admission to discharge (AC). Secondary outcomes included length of hospital stay (LOS), intensive care unit (ICU) admission, costs 30 days after discharge (AD), and cumulative costs (CC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 384 patients received selective, and 418 patients received nonselective alpha-blockade. The median age was 58 years (IQR 21 years). Median AB was significantly lower in the selective compared with nonselective alpha-blockade group ($19.73 versus $1033.70,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.001). Median AC ($31,104.47 versus $31,471.90,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.428) and AD ($790.78 versus $715.10,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.074) were not significantly different between selective compared with nonselective alpha-blockade groups. On multivariable regression modeling, higher Elixhauser score (coeff.: $1,801.20,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.001) and longer LOS (coeff.: $1842.33,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;\u20090.001) were associated with higher CC, while age (coeff.: $\u2212\u2009143.22,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.044) was associated with lower CC. Notably, alpha-blockade strategy was not significantly associated with CC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When compared with nonselective alpha blockers, selective alpha blockers are associated with lower medication costs but equivalent hospitalization and post-hospitalization costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19255-3","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T13:34:35Z","timestamp":1771594475000},"page":"5651-5658","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["What is the Cost of Selectivity? Selective and Nonselective Alpha Blockade Costs Associated with Adrenalectomy for Pheochromocytoma"],"prefix":"10.1245","volume":"33","author":[{"given":"Lauren R.","family":"Kelz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse E.","family":"Passman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen","family":"Brensinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily","family":"Owei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara P.","family":"Ginzberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3786-3638","authenticated-orcid":false,"given":"Heather","family":"Wachtel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"issue":"3","key":"19255_CR1","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1515\/enr-2017-0018","volume":"51","author":"FA Farrugia","year":"2017","unstructured":"Farrugia FA, Martikos G, Tzanetis P, et al. Pheochromocytoma, diagnosis and treatment: review of the literature. Endocr Regul. 2017;51(3):168\u201381.","journal-title":"Endocr Regul."},{"issue":"1","key":"19255_CR2","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.hoc.2015.09.006","volume":"30","author":"L Fishbein","year":"2016","unstructured":"Fishbein L. Pheochromocytoma and paraganglioma: genetics, diagnosis, and treatment. Hematol Oncol Clin North Am. 2016;30(1):135\u201350.","journal-title":"Hematol Oncol Clin North Am."},{"issue":"4","key":"19255_CR3","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00423-019-01768-z","volume":"404","author":"K Lorenz","year":"2019","unstructured":"Lorenz K, Langer P, Niederle B, et al. Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK). 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J Clin Endocrinol Metab. 2014;99(6):1915\u201342.","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"19255_CR6","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1001\/jamasurg.2022.3544","volume":"157","author":"L Yip","year":"2022","unstructured":"Yip L, Duh QY, Wachtel H, et al. American association of endocrine surgeons guidelines for adrenalectomy: executive summary. JAMA Surg. 2022;157(10):870\u20137.","journal-title":"JAMA Surg."},{"issue":"6","key":"19255_CR7","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1530\/EJE-20-1301","volume":"184","author":"K Zawadzka","year":"2021","unstructured":"Zawadzka K, Wi\u0119ckowski K, Ma\u0142czak P, et al. Selective versus non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma: systematic review and meta-analysis. Eur J Endocrinol. 2021;184(6):751\u201360.","journal-title":"Eur J Endocrinol."},{"issue":"1","key":"19255_CR8","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1245\/s10434-016-5514-7","volume":"24","author":"RW Randle","year":"2017","unstructured":"Randle RW, Balentine CJ, Pitt SC, Schneider DF, Sippel RS. Selective versus non-selective \u03b1-blockade prior to laparoscopic adrenalectomy for pheochromocytoma. Ann Surg Oncol. 2017;24(1):244\u201350.","journal-title":"Ann Surg Oncol."},{"issue":"3","key":"19255_CR9","volume":"17","author":"DQ Le","year":"2025","unstructured":"Le DQ, Burton BN, Tejeda CJ, Hong JC, Lee JS, Kamdar N. Drug price and health policy knowledge influence prescription behavior in orphan diseases: pheochromocytoma and paraganglioma as prototypes of orphan drug econometrics. 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Pre-operative selective vs non-selective \u03b1-blockade in pheochromocytoma-paraganglioma patients undergoing surgery: a meta-analysis. Indian J Endocrinol Metab. 2022;26(1):4\u201312.","journal-title":"Indian J Endocrinol Metab."},{"issue":"1","key":"19255_CR13","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1213\/ANE.0000000000005070","volume":"132","author":"H Kong","year":"2021","unstructured":"Kong H, Li N, Yang XC, Nie XL, Tian J, Wang DX. Nonselective compared with selective \u03b1-blockade is associated with less intraoperative hypertension in patients with pheochromocytomas and paragangliomas: a retrospective cohort study with propensity score matching. Anesth Analg. 2021;132(1):140\u20139.","journal-title":"Anesth Analg."},{"issue":"8","key":"19255_CR14","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1530\/EC-17-0232","volume":"6","author":"C Liu","year":"2017","unstructured":"Liu C, Lv Q, Chen X, et al. 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