title: Postoperative rhabdomyolysis following robotic renal and adrenal surgery: a cautionary tale of compounding risk factors.
abstract: This study aimed at reviewing a contemporary series of patients who underwent robotic renal and adrenal surgery by a single surgeon at a tertiary referral academic medical center over a 6-year period, specifically focusing on the unique and serious complication of post-operative rhabdomyolysis of the dependent lower extremity. The cases of 315 consecutive patients who underwent robotic upper tract surgery over a 6-year period from August 2008 to June 2014 using a standardized patient positioning were reviewed and analyzed for patient characteristics and surgical variables that may be associated with the development of post-operative rhabdomyolysis. The incidence of post-operative rhabdomyolysis in our series was 3/315 (0.95%). All three affected patients had undergone robotic nephroureterectomy. Those patients who developed rhabdomyolysis had significantly higher mean Body Mass Index, Charlson Comorbidity Index, and median length of stay than those who did not. The mean OR time in the rhabdomyolysis group was noted to be 52 min longer than the non-rhabdomyolysis group, though this value did not reach statistical significance. Given the trends of increasing obesity in the United States and abroad as well as the continued rise in robotic upper tract urologic surgeries, urologists need to be increasingly vigilant for recognizing the risk factors and early treatment of the unique complication of post-operative rhabdomyolysis.
authors.affiliation: Division of Robotic and Minimally Invasive Urologic Surgery, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100247, 32610-0247, Gainesville, FL, USA.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Terry
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Gerke
authors.affiliation: Division of Robotic and Minimally Invasive Urologic Surgery, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100247, 32610-0247, Gainesville, FL, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Mason
authors.affiliation: Division of Robotic and Minimally Invasive Urologic Surgery, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100247, 32610-0247, Gainesville, FL, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Sorensen
authors.affiliation: Division of Robotic and Minimally Invasive Urologic Surgery, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100247, 32610-0247, Gainesville, FL, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Joseph
authors.affiliation: Minneapolis Veterans Affairs Health Care System, Urology Section and Department of Urology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.affiliation: Division of Robotic and Minimally Invasive Urologic Surgery, Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100247, 32610-0247, Gainesville, FL, USA. sulm@ufl.edu.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Su
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
keywords: Obesity; Rhabdomyolysis; Robotics; Upper tract urologic surgery