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CUAJ %u2022 FEBRUARY 2025 %u2022 VOLUME 19, ISSUE 2 %u00a9 2025 CANADIAN UROLOGICAL ASSOCIATION 53ORIGINAL RESEARCHINTRODUCTIONAdrenal masses are being diagnosed with increasing frequency, which is partially attributed to the increased use of axial cross-sectional imaging.1Combined with the development of minimally invasive surgical techniques, this has led to an increase in the rate of adrenalectomies performed over the past several decades.2Adrenalectomies have historically been performed by general surgeons and urologists, with both specialties having expertise in the surgical anatomy of the retroperitoneum; however, proportionately fewer adrenalectomies have been performed by urologists over time,3 despite the lack of strong evidence to suggest that surgical subspecialty has an impact on patient outcomes following adrenalectomy.3,4 In a Canadian context, adrenalectomies are performed by both specialties but very little is known about outcomes, trends over time, and patterns of practice. The role of surgical specialty on patient outcomes has been documented in several other types of operations. Thoracic surgeons had lower operative mortality rates after esophageal cancer resection and lung resection than did other surgeons.5,6In addition, vascular surgeons were found to have lower in-hospital mortality rates after carotid endarterectomy than did neurosurgeons and general surgeons.7Over the last decade, Kingston Health Sciences Centre (KHSC) has been the setting of over 100 adrenalectomies performed by both urologists and general surgeons. Using a single-center, retrospective chart INTRODUCTION: Management of adrenal disease requires a multidisciplinary approach often involving varied specialists. Surgical management has often overlapped between general surgeons, usually with an interest in surgical endocrinology, or urologists with minimally invasive surgical skills. The objectives of this study were to define perioperative outcomes of contemporary Canadian adrenal surgery and determine whether those outcomes are impacted by surgical subspecialty. As a secondary outcome, an assessment of the variability in the indications for adrenal surgery was carried out between the two surgical subspecialties.METHODS: A retrospective chart review of all adrenalectomies performed at our center from August 2013 to August 2023 was conducted. The only exclusion criterion was when an adrenalectomy was performed secondary to the main procedure. Data was collected and grouped under four categories: patient characteristics, indications for an adrenalectomy, procedural statistics, and perioperative patient outcomes. RESULTS: A total of 121 adrenalectomies were performed in a period of just over 10 years. Of these, 103 were included in the analysis. Thirty-seven were performed by general surgery, whereas 66 were performed by urology. There were no significant differences in patients%u2019 age and Charlson comorbidity score between the two surgical specialties. The indications for the adrenalectomy were similar between the specialties, and were as follows: 32 (31.1%) for pheochromocytoma, 24 (23.3%) for a cortical functional lesion, 19 (18.4%) for a metastatectomy, 16 (15.5%) for size or growth, and 10 (9.7%) for adrenocortical carcinoma. There were no differences in overall operating room time or type of procedure. Most (89.3%) of the procedures were performed laparoscopically. Patients that were operated on by general surgeons were more likely to be readmitted within 30 days than those operated on by urologists (five patients [13.5%] vs. one patient [1.5%], respectively, p=0.04), and more likely to require intensive care unit (ICU)/stepdown ICU admission (19 patients [51.4%] vs. 19 [28.8%], respectively, p=0.04). There was no difference in length of stay or postoperative complications. There was, however, one Clavien-Dindo 5 complication after a procedure performed by general surgery. CONCLUSIONS: Most adrenalectomies at this one Canadian center are performed by urology. Indications for adrenalectomy are similar between the specialties. Although postoperative complication rates are similar, rates of 30-day readmission and ICU/stepdown admission were decreased when urologists performed adrenalectomies. Adrenalectomies may be performed safely by either specialty, and factors such as local expertise and surgical volumes are likely important.ABSTRACTBasil Ahmad1, Duva Karunakaran1, Naji J.Touma21Queen%u2019s University School of Medicine, Kingston, ON, Canada; 2Department of Urology, Queen%u2019s University, Kingston, ON Canada Cite as: Ahmad B, Karunakaran D, Touma NJ. Perioperative outcomes of adrenal surgery: Does surgical specialty matter? Can Urol Assoc J 2025;19(2):53-7. http://dx.doi.org/10.5489/cuaj.7852Published online December 9, 2024Perioperative outcomes of adrenal surgeryDoes surgical specialty matter?