title: The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis.
abstract: OBJECTIVE
  We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery.
  
  
  METHODS
  We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery 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 V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay.
  
  
  RESULTS
  The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p <0.05) and higher 90-day mortality (4.4% vs 1.02%, p <0.05). Length of stay was twice as long for patients with postoperative rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p <0.001). The robotic approach was associated with a higher likelihood of postoperative rhabdomyolysis (vs laparoscopic approach, OR 2.43, p <0.05). Adjusted 90-day median direct hospital costs were USD 7,515 higher for patients with postoperative rhabdomyolysis (p <0.001). Our model revealed that the combination of obesity and prolonged surgery (more than 5 hours) was associated with a higher likelihood of postoperative rhabdomyolysis developing.
  
  
  CONCLUSIONS
  Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis.
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Francisco
authors: F
authors: Gelpi-Hammerschmidt
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Marmara University School of Medicine, Istanbul, Turkey. Electronic address: itinay@partners.org.
authors: Ilker
authors: I
authors: Tinay
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Christopher B
authors: CB
authors: Allard
authors: Department of Urology, University of Florida College of Medicine, Gainesville, Florida.
authors: Li-Ming
authors: LM
authors: Su
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Mark A
authors: MA
authors: Preston
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Adam S
authors: AS
authors: Kibel
authors: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Ye
authors: Y
authors: Wang
authors: Department of Urology, Stanford University Medical Center, Stanford, California.
authors: Benjamin I
authors: BI
authors: Chung
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Steven L
authors: SL
authors: Chang
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology* / Q000401:mortality; D065287:Robotic Surgical Procedures; D014481:United States / Q000453:epidemiology
keywords: kidney; operative; population groups; rhabdomyolysis; surgical procedures