The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis

Abstract

To evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis (PRM) following extirpative renal surgery (ERS).We conducted a population-based, retrospective cohort study of patients who underwent ERS with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade 5), non-fatal major complications (Clavien grade 3-4), readmission rates, direct costs and length of stay (LOS).The final weighted cohort included 310,880 open, 174,283 laparoscopic, and 69,880 robotic ERS during the 10-year study period, with 745 (0.001%) experiencing PRM. Presence of PRM led to a significantly higher incidence of 90-day non-fatal major complications (34.7% vs. 7.3%, p<0.05) and higher 90-day mortality (4.4% vs. 1.02%, p<0.05). LOS was twice as long for patients with PRM (incidence risk ratio: 1.83, 95% CI: 1.56-2.15, p<0.001). Robotic approach was associated with a higher likelihood for PRM (vs. laparoscopic approach, odds ratio: 2.43, p<0.05). Adjusted 90-day median direct hospital costs were USD 7515 higher for patients with PRM (p<0.001). Our model revealed that the combination of obesity and prolonged surgery (>5 hours) was associated with a higher likelihood of developing PRM.Our study confirms that PRM is an uncommon complication among patients undergoing ERS but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities as well as obesity, prolonged surgery (>5 hours), and a robotic approach appear to place patients at a higher risk for PRM.

View details for DOI 10.1016/j.juro.2015.08.084

View details for Web of Science ID 000368054800052