Adrenal masses are being found more and more often over the years. Given the association of these masses with advancing age, the decision to perform surgery in older, sometimes asymptomatic patients presents a clinical dilemma. These patients are potentially more vulnerable to adverse postoperative outcomes due to increased frailty. Therefore, this study aimed to compare the postoperative course after adrenalectomy in patients aged 70 years and older to that of a younger cohort. This single center retrospective study included patients aged ≥ 70 years who underwent adrenalectomy between 2000-2020, and propensity-score matched younger patients (<
70 years). Patients were matched based on hormonal overproduction, malignant diagnosis, surgical approach and year of surgery. The study included 77 elderly patients (median age 74 years) and 77 younger patients (median age 52 years
p <
0.002). Serious complications (Clavien-Dindo ≥ 3) occurred in 9.1% of elderly patients and 6.5% of the matched younger cohort (p = 0.773). The overall complication rate was 44.2% in elderly and 40.3% in younger patients (p = 0.771), with similar duration of hospital admission and mortality in both groups. Elderly patients experienced mostly infectious (33.8%) or cardiovascular complications (27.0%), and cardiovascular complications were more frequent in elderly than in younger patients (6.7%, p = 0.039). In conclusion, patients aged 70 years and older who undergo adrenalectomy have a similar postoperative course and complication rate as younger patients, with most postoperative complications being minor, and mortality being minimal. Therefore, older age itself should not be a reason to refrain from adrenalectomy.