The Mayo Adhesive Probability score as a predictor of surgical outcomes in adrenalectomy: a systematic review and meta-analysis

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The Mayo Adhesive Probability (MAP) score, derived from preoperative computed tomography, quantifies perinephric fat thickness and stranding. While originally developed for nephrectomy, its utility in predicting surgical outcomes for adrenalectomy remains to be systematically assessed. We systematically searched MEDLINE, Cochrane Library, and Embase up to May 1, 2026, for cohort studies evaluating the association between the MAP score and perioperative outcomes in patients undergoing adrenalectomy. The primary outcomes were operative time, estimated blood loss, and postoperative complications. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models with the Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity was assessed using the I² statistic. Subgroup analysis by geographic region was performed. Five retrospective cohort studies comprising 578 patients were included. A high MAP score was significantly associated with prolonged operative time (OR = 4.91, 95% CI: 3.06–7.90, I² = 3.5%), increased blood loss (OR = 5.35, 95% CI: 2.44–11.74, I² = 60.1%), and higher odds of overall complications (OR = 3.20, 95% CI: 1.62–6.33, I² = 22.5%). Subgroup analysis by country revealed a stronger effect in Turkish studies (OR = 6.40, 95% CI: 2.41–16.98, I² = 0.0%) compared to Chinese studies (OR = 1.65, 95% CI: 0.63–4.28, I² = 0.0%), with a borderline significant between-group difference ( p = 0.052). A higher MAP score predicts worse surgical outcomes in adrenalectomy, including longer operative time, greater blood loss, and increased complication risk. The MAP score may serve as a potential tool for preoperative risk assessment, though prospective validation in larger, multicenter cohorts is needed before clinical implementation.