MP29-10 RHABDOMYOLYSIS AFTER MAJOR UROLOGIC SURGERY: INCIDENCE, RISK FACTORS AND OUTCOMES

Field: Medicine (Health Sciences)

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-10 RHABDOMYOLYSIS AFTER MAJOR UROLOGIC SURGERY: INCIDENCE, RISK FACTORS AND OUTCOMES Joseph J. Pariser, Shane M. Pearce, Sanjay G. Patel, Vignesh T. Packiam, Blake B. Anderson, Arieh L. Shalhav, Gregory T. Bales, and Norm D. Smith Joseph J. PariserJoseph J. Pariser More articles by this author , Shane M. PearceShane M. Pearce More articles by this author , Sanjay G. PatelSanjay G. Patel More articles by this author , Vignesh T. PackiamVignesh T. Packiam More articles by this author , Blake B. AndersonBlake B. Anderson More articles by this author , Arieh L. ShalhavArieh L. Shalhav More articles by this author , Gregory T. BalesGregory T. Bales More articles by this author , and Norm D. SmithNorm D. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.613AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rhabdomyolysis (RM) is a rare condition of rapid muscle breakdown resulting in pain, renal failure or even death. The largest studies in urology patients include very few (n < 10) patients with RM. We studied the incidence, risk factors and outcomes of RM after major urologic surgery using a large, national database. METHODS The National Inpatient Sample (2003-2011) was used to identify patients who underwent prostatectomy (RP), radical or partial nephrectomy (Nx) or radical cystectomy (RC). Two cohorts were created based on diagnosis of RM. Demographics included age, gender, race and comorbidities. Factors examined included blood transfusion, hospital teaching status, hospital volume, if the surgery was performed minimally invasively (MIS) and if the patient suffered from RM. Weighted multivariate logistic regression was used to identify risk factors of RM. Outcomes of mortality, acute kidney injury (AKI), length of stay (LOS) and hospital charges were compared to controls. RESULTS 206,248 records were identified for a weighted national population of 884,574 patients. Overall, 870 (0.1%) patients suffered from RM (0.2% of RC, 0.2% of Nx and 0.04% of RP). Patients with RM had more comorbidities (Elixhauser 4+: 37% vs 5%), were more likely to have diabetes (DM) (35% vs 16%), chronic kidney disease (CKD) (23% vs 4%) and obesity (29% vs 6%) (all p<0.01). A greater proportion of RM cases occurred in teaching hospitals (73% vs 64% p=0.03). 5% of RM patients underwent fasciotomy. On multivariate analysis, independent risk factors for development of RM included overall comorbidity, CKD and obesity with a protective effect from female gender and older age. MIS and DM were not independently associated in development of RM. In subgroup analyses, obesity (OR: 2.19 p<0.01) was only a risk factor for RM in the Nx cohort. RM was associated with increased mortality (OR=10.0), AKI (OR=51.2), LOS (10.9 vs 4.0 days) and charges ($116,753 vs $40,636) (all p<0.01). CONCLUSIONS Rhabdomyolysis is rare after urologic surgery. In a national database, 870 patients with RM were examined to identify the risk factors of male gender, lower age, overall comorbidity, chronic kidney disease and obesity. These patients have an increased risk of AKI, mortality, longer hospital stay and increased charges. Multivariate Analysis of Risk Factors for Rhabdomyolysis Factor Odds Ratio 95% CI p-value Age (per year increase) 0.96 0.94-0.97 < 0.01 Female Gender (Ref: Male) 0.60 0.38-0.93 0.02 Elixhauser Comorbidity (Ref: 0) 1-3 3.69 1.90-7.17 < 0.01 ≥ 4 15.68 6.90-35.62 < 0.01 Chronic Kidney Disease 2.13 1.32-3.41 < 0.01 Obesity 2.10 1.37-3.22 < 0.01 Diabetes 1.06 0.74-1.53 0.73 Minimally Invasive Approach 1.38 0.90-2.11 0.14 Teaching Hospital 1.32 0.81-2.17 0.15 Procedure (Ref: Prostatectomy) Nephrectomy 2.22 1.40-3.54 < 0.01 Cystectomy 2.31 1.10-4.86 0.03 *Controlling for race, transfusion, hospital volume (data not shown) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e343 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph J. Pariser More articles by this author Shane M. Pearce More articles by this author Sanjay G. Patel More articles by this author Vignesh T. Packiam More articles by this author Blake B. Anderson More articles by this author Arieh L. Shalhav More articles by this author Gregory T. Bales More articles by this author Norm D. Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...