Does Laterality Affect the Risk of Intraoperative Complications in Adrenalectomy?

To test the effect of laterality on the risk of intraoperative complications (ICs) in a contemporary cohort of adrenalectomy patients.

Within the Nationwide Inpatient Sample (NIS) database (2015-2019), we identified patients who underwent either minimal-invasive or open adrenalectomy. Multivariable logistic regression models tested for the association of laterality and IC. Additionally, this association was further tested in specific subgroups, namely patients with elevated body mass index (BMI) ≥ 30, patients who underwent minimal-invasive adrenalectomy, and patients who underwent open adrenalectomy.

Overall, we identified 4887 patients who underwent adrenalectomy. Of those, 2143 (44%) were right-sided, and 2744 (56%) left-sided. An IC was recorded in 90 (1.8%) patients. Right-sided adrenalectomy had significantly more IC compared to left-sided adrenalectomy (2.6% vs. 1.3%, p < 0.001). After multivariable adjustment, right side emerged as an independent predictor for IC (OR 1.9, p = 0.007). In subgroup analysis, right-side remained an independent predictor for IC in patients with BMI ≥ 30 (OR 4.08 p = 0.003) and minimal-invasive adrenalectomy (OR 2.3 p = 0.01) patients.

ICs in adrenalectomy are rare, but are associated with high morbidity. Right-sided adrenalectomy carries an increased risk for IC. Conversely, surgeons should exercise particular caution when approaching the right adrenal gland to mitigate the associated risks and enhance patient outcomes.