Evaluation of the adrenal and MAP scores as predictors of postoperative complications after adrenalectomy

Introduction The ADRENAL score is based on preoperative endocrine, clinical, and radiological parameters, enabling the assessment of surgical complexity and prediction of perioperative risk in adrenal surgery. The Mayo Adhesive Probability (MAP) score is derived from preoperative computed tomography findings and evaluates the degree of perinephric or periadrenal fat adhesiveness, a factor that may increase the technical complexity of surgery. The aim of this study was to compare the performance of the ADRENAL and MAP scores in predicting postoperative complications in patients undergoing adrenalectomy.Patients and methods This was a retrospective, multicenter study including all patients who underwent adrenalectomy between 2015 and 2025. The ADRENAL score was calculated using preoperative data, whereas the MAP score was categorized as low (0–1) or high (>1). Preoperative and perioperative variables, including tumor size, estimated blood loss, operative time, and postoperative complications, were compared between groups. Logistic regression analyses were performed to identify predictors of postoperative complications. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative performance of the ADRENAL and MAP scores.Results A total of 232 patients were included. The mean age was 58.45 ± 8.36 years. Postoperative complications occurred in 45 patients (19.39%). Patients who developed postoperative complications had significantly larger tumors (p = 0.01), higher estimated blood loss (p = 0.02), longer operative times (p = 0.047), and significantly higher ADRENAL (p < 0.001) and MAP (p = 0.03) scores. On multivariable analysis, both the ADRENAL score (OR = 4.628; 95% CI: 3.214–8.907; p = 0.001) and the MAP score (OR = 7.058; 95% CI: 2.216–27.2; p = 0.03) remained independent predictors of postoperative complications. The ADRENAL score demonstrated superior discriminative ability compared with the MAP score, with an area under the ROC curve (AUC) of 0.835 versus 0.715, respectively.Conclusion The ADRENAL and MAP scores are useful tools for predicting postoperative complications after adrenalectomy and may be incorporated into preoperative assessment to improve surgical risk estimation. The ADRENAL score demonstrated superior predictive performance in our cohort and may represent a particularly valuable tool for perioperative risk stratification.