Influence of obesity and overweight in surgical outcomes of adrenalectomy for primary adrenal disease. A cohort study of 146 cases

Abstract

Abstract Objective: To evaluate the impact of obesity and overweight on surgical outcomes in a large cohort of patients who underwent adrenalectomy due to primary adrenal benign or malignant disease. Methods: A retrospective unicentric study of patients without history of active extraadrenal malignancy with adrenal tumors consecutively operated in our center during January 2010 and December 2022. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2 and overweight as BMI between 25.0 and 30.0 kg/m2. Results: Of 146 patients with adrenal tumors who underwent adrenalectomy, 9.6% (n=14) had obesity, 54.8% (n=80) overweight and 35.6% (n=52) normal weight. Obese patients had higher levels of diastolic blood pressure (87.6±12.22 vs. 79.3±10.23 mmHg, P=0.010) and a higher prevalence of dyslipidemia (57.1% vs. 25.8%, P=0.014) and of bilateral tumors (14.3% vs. 3.1%, P=0.044) than non-obese patients. The rate of intraoperative and of postsurgical complications were similar between obese/overweight patients and patients with normal weight. However, a significant rate of postsurgical complications (27.3% vs. 5.7%, P=0.009) and a longer hospital stay (5.4±1.39 vs. 3.5±1.78 days, P=0.007) were observed in patients with obesity than in non-obese. In the multivariant analysis, obesity, age, ASA>2 and tumor size were independent risk factors of postoperative complications, being obesity the most important factor (OR 23.34 [2.23-244.24]). Conclusion: Obesity and overweight are common conditions in patients who underwent adrenalectomy. Adrenalectomy is considered a safe procedure in patients with overweight, but it is associated with a higher risk of postsurgical complications and longer hospital stay in obese patients.