Purpose This study evaluates the predictive value of the Mayo Adhesive Probability (MAP) score for surgical outcomes in obese patients undergoing miniaturized percutaneous nephrolithotomy (m-PCNL). The primary research question is whether the MAP score can predict intraoperative and postoperative complications in patients with a body mass index (BMI) greater than 30. Methods A retrospective analysis was conducted on patients who underwent m-PCNL at a tertiary care center between August 2018 and August 2023. Patients with kidney stones larger than 2 cm and a BMI >
30 were included. They were categorized based on MAP scores (<
3 vs. ≥3). Data on operation time, fluoroscopy time, hospital stay, and complications were compared. Statistical analyses included t-tests, chi-square tests, and logistic regression to assess risk factors for postoperative fever. Results Among 87 patients, those with a MAP score ≥3 had a significantly higher rate of postoperative fever (17.1% vs. 3.8%, p = 0.035). There were no significant differences between groups in operation time, fluoroscopy time, hospital stay, or blood transfusion needs. Logistic regression showed that a higher MAP score (OR: 6.614, p = 0.045) and increased stone burden (OR: 1.003, p = 0.040) were significant predictors of postoperative fever. Conclusion The MAP score is a significant predictor of postoperative fever in obese patients undergoing m-PCNL. Higher MAP scores are associated with a greater risk of fever, suggesting that careful monitoring and preventive measures are essential for patients with higher MAP scores. Further multicenter studies are needed to validate these findings and improve predictive accuracy.