MP84-10 THE CONTEMPORARY INCIDENCE AND CONSEQUENCES OF RHABDOMYOLYSIS FOLLOWING RENAL SURGERY: A POPULATION-BASED ANALYSIS

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You have accessJournal of UrologyKidney Cancer: Surgical Therapy VII1 Apr 2015MP84-10 THE CONTEMPORARY INCIDENCE AND CONSEQUENCES OF RHABDOMYOLYSIS FOLLOWING RENAL SURGERY: A POPULATION-BASED ANALYSIS Francisco Gelpi-Hammerschmidt, Ilker Tinay, Christopher Allard, Li-Ming Su, Mark Preston, Adam Kibel, Ye Wang, Deborah Hess, James Hwong, Benjamin Chung, and Steven Chang Francisco Gelpi-HammerschmidtFrancisco Gelpi-Hammerschmidt More articles by this author , Ilker TinayIlker Tinay More articles by this author , Christopher AllardChristopher Allard More articles by this author , Li-Ming SuLi-Ming Su More articles by this author , Mark PrestonMark Preston More articles by this author , Adam KibelAdam Kibel More articles by this author , Ye WangYe Wang More articles by this author , Deborah HessDeborah Hess More articles by this author , James HwongJames Hwong More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1977AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The development of postoperative rhabdomyolysis (PRM) is a rare and poorly characterized complication associated with renal surgery. We performed a population-based study to evaluate contemporary incidence and consequences of PRM following extirpative renal surgery in the United States. METHODS Our study cohort was comprised of patients undergoing renal surgery (ICD9 55.4 and 55.5x) from 2004 to 2013, from the Premier Hospital Database (Premier Inc., Charlotte, NC), a nationally representative hospital discharge database. The development of PRM was identified through the charge data (ICD9 728.88). We evaluated the study cohort with descriptive statistics and fit multivariable regression models, adjusting for clustering by hospitals and survey weighting, to assess 90-day postoperative complications, mortality, length of stay (LOS) and direct hospital costs. RESULTS The weighted cohort included 310880 open, 174283 laparoscopic, and 69880 robotic renal surgeries during the 10-year study period, with 944 (0.002%) experiencing PRM. The overall 90-day morbidity and mortality was higher among patients developing PRM (table1). LOS was higher for patients with rhabdomyolysis (Incidence Risk Ratio [IRR]: 1.98, 95% CI: 1.71-2.3, p <0.001) compared to patients without rhabdomyolysis. The incidence of PRM was higher for patients undergoing a robotic procedure compared to a laparoscopic approach (Odds Ratio [OR]: 2.46, p=0.008). Adjusted 90-day median direct hospital costs were $10751 higher for patients with PRM (p<0.001). Our model revealed that the combination of obesity and prolonged surgery (operating room time [OT] >6 hours) was associated with a higher likelihood of developing PRM (Figure 1). CONCLUSIONS Our study confirms that PRM is an uncommon complication among patients undergoing extirpative renal surgery but has a potentially detrimental impact on surgical morbidity, mortality and costs. Obesity, prolonged surgery (>6 hours), and a robotic approach appear to place patients at a higher risk for PRM. Table 1. Adjusted 90-day mortality and major complication rates among patients undergoing extirpative renal surgery that developed PRM versus those not developing PRM. PRM present PRM absent p-value Mortality 6.5% 1.3% 0.0126 Major Complication (Clavien 3-5) 8.2% 1.7% 0.173 Figure 1. The incidence of rhabdomyolysis in obese and non-obese patients at different operative time (OT) intervals © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1061-e1062 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francisco Gelpi-Hammerschmidt More articles by this author I