Does Laterality Affect the Risk of Intraoperative Complications in Adrenalectomy?

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Adrenal Gland Surgery

Background:

• Intraoperative complications (ICs) during adrenalectomy, while rare, can lead to significant patient morbidity.
• Understanding risk factors, such as surgical side, is crucial for improving patient safety and outcomes.

Purpose of the Study:

• To evaluate the impact of laterality (right vs. left) on the risk of intraoperative complications in patients undergoing adrenalectomy.
• To identify if surgical side is an independent predictor of complications in contemporary adrenalectomy patients.

Main Methods:

• Analysis of the Nationwide Inpatient Sample (NIS) database from 2015-2019.
• Inclusion of patients who underwent either minimally invasive or open adrenalectomy.
• Multivariable logistic regression models were used to assess the association between laterality and ICs, including subgroup analyses for patients with elevated BMI and different surgical approaches.

Main Results:

• A total of 4887 adrenalectomy patients were analyzed; 44% right-sided and 56% left-sided.
• The overall incidence of ICs was 1.8%, with significantly higher rates for right-sided adrenalectomies (2.6%) compared to left-sided (1.3%, p < 0.001).
• Right-sided adrenalectomy was an independent predictor of ICs (OR 1.9, p=0.007), persisting in subgroups with BMI ≥ 30 and minimally invasive procedures.

Conclusions:

• Right-sided adrenalectomy is associated with a higher risk of intraoperative complications.
• Surgeons should be particularly vigilant when operating on the right adrenal gland to minimize risks.
• Adopting specific precautions for right-sided adrenalectomies may help mitigate complications and improve surgical outcomes.