Presentation Details
| Development and Implementation of a Standardized Multidisciplinary Protocol for the Perioperative Evaluation of Adrenal Incidentalomas Lindsey Gerstein1, Sarah Elbaz2, Tiffany Mach1, Leonardo Lamanuzzi1, Teresa Cafaro1. 1Department of Medicine, McGill University, Montreal, QC, Canada.2Department of Family Medicine, McGill University, Montreal, QC, Canada |
Abstract
BACKGROUND: Adrenal incidentalomas are relatively common in adults and are often first addressed during preoperative evaluation. Although rare, undiagnosed pheochromocytomas can pose serious perioperative risks, and adrenal incidentalomas in the preoperative setting frequently trigger extensive workups that may delay surgery. Currently, no standardized approach exists for efficiently and safely evaluating adrenal incidentalomas in patients requiring urgent or semi-urgent surgery. To address this gap, we developed and implemented a multidisciplinary protocol designed to streamline assessment, minimize unnecessary investigations, and prevent surgical delays while ensuring patient safety.
PURPOSE: In consultation with anesthesiology, surgery, endocrinology, radiology, and medical biochemistry, we developed a standardized pathway for adrenal incidentaloma evaluation prior to surgery. The protocol outlines essential imaging, biochemical testing, consultation criteria, and timelines according to surgical urgency. Implementation included stakeholder engagement, integration into preoperative workflows, and dissemination through departmental meetings, educational sessions, and electronic platforms.
RESULTS: Following implementation, the protocol was successfully incorporated into preoperative screening workflows at our institution. Perioperative physicians reported improved clarity regarding appropriate testing, as well as the timing and indications for consultant involvement. Early feedback highlighted increased confidence in managing adrenal incidentalomas efficiently, reducing unnecessary investigations, and enhancing interdisciplinary communication—particularly in urgent or semi-urgent cases.
CONCLUSIONS: A standardized perioperative adrenal incidentaloma protocol can improve patient safety and streamline interdisciplinary coordination by facilitating timely assessment of adrenal nodules before surgery. This approach provides a reproducible framework for incorporating structured diagnostic pathways into perioperative care, minimizing unnecessary testing and preventing surgical delays while mitigating preventable intraoperative risks.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: In consultation with anesthesiology, surgery, endocrinology, radiology, and medical biochemistry, we developed a standardized pathway for adrenal incidentaloma evaluation prior to surgery. The protocol outlines essential imaging, biochemical testing, consultation criteria, and timelines according to surgical urgency. Implementation included stakeholder engagement, integration into preoperative workflows, and dissemination through departmental meetings, educational sessions, and electronic platforms.
RESULTS: Following implementation, the protocol was successfully incorporated into preoperative screening workflows at our institution. Perioperative physicians reported improved clarity regarding appropriate testing, as well as the timing and indications for consultant involvement. Early feedback highlighted increased confidence in managing adrenal incidentalomas efficiently, reducing unnecessary investigations, and enhancing interdisciplinary communication—particularly in urgent or semi-urgent cases.
CONCLUSIONS: A standardized perioperative adrenal incidentaloma protocol can improve patient safety and streamline interdisciplinary coordination by facilitating timely assessment of adrenal nodules before surgery. This approach provides a reproducible framework for incorporating structured diagnostic pathways into perioperative care, minimizing unnecessary testing and preventing surgical delays while mitigating preventable intraoperative risks.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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