Rhabdomyolysis After Tracheobronchoplasty: Incidence, Predictors, and Association With Postoperative Outcomes

Prolonged intraoperative immobility during tracheobronchoplasty (TBP) can cause rhabdomyolysis. We investigated the incidence of rhabdomyolysis after TBP and its association with postoperative outcomes.

We conducted a single-center review of TBP patients between 2008 and 2024. Patients were dichotomized by the severity of rhabdomyolysis. Outcomes included postoperative acute kidney injury (AKI), complications, readmissions, hospital length of stay, and disposition. The Fisher's exact test, Wilcoxon rank sum test, and stepwise logistic regression were used for analyses.

A total of 232 patients were included; 11 (4.7%) did not develop rhabdomyolysis. In total, 131 (56.4%) developed mild, 85 (36.6%) developed moderate, and 5 (2.1%) developed severe rhabdomyolysis. Patients with moderate/severe rhabdomyolysis had higher body mass index (BMI; 33.5 versus 32.3, P = 0.02), more frequently underwent open TBP (96.7% versus 71.8%, P < 0.01), and had longer operations (424 versus 406 min, P = 0.02). AKI was more prevalent in the moderate/severe group (18.9% versus 11%, P = 0.01). There were no differences in other complications, intensive care unit, and hospital length of stay, discharge disposition, and readmissions. Predictors of moderate/severe rhabdomyolysis included age (odds ratio [OR] 0.944, 95% confidence interval [CI] 0.914-0.974, P < 0.001), male sex (OR 2.907, 95% CI 1.372-6.161, P = 0.005), BMI (OR 1.080, 95% CI 1.022-1.140, P = 0.006), open approach (OR 54.014, 95% CI 10.579-275.771, P < 0.001), and operative time (OR 1.009, 95% CI 1.003-1.015, P = 0.001).

Most TBP patients develop rhabdomyolysis; few develop severe cases. Moderate/severe rhabdomyolysis is linked to younger age, male sex, higher BMI, open approach, and longer operations. Despite higher incidence of AKI, complication rates are similar, likely due to timely recognition of high-risk patients.