Postoperative rhabdomyolysis following otoplasty: an autopsy case report

Postoperative rhabdomyolysis is a significant complication that can arise from prolonged surgery, causing potential harm to the kidneys and leading to acute renal failure. Despite its importance, the incidence of rhabdomyolysis following ear reconstruction surgery remains undocumented in the literature. In this report, we present a case study of a male patient in his forties who underwent otoplasty for ear reconstruction after the amputation of his right ear due to a physical assault. The surgery lasted for 8 h under general anesthesia, and unfortunately, the patient developed postoperative rhabdomyolysis, which resulted in severe renal failure and ultimately an unrecoverable cardiac arrest, leading to his death. The autopsy findings indicated no identifiable lesions except for organ congestion, while histopathology revealed acute tubular necrosis of the kidney and muscle rhabdomyolysis. Previous literature has explored the association between surgical duration, location, and rhabdomyolysis, underscoring that this condition is an infrequent yet preventable consequence of prolonged surgery. The co-occurrence of rhabdomyolysis and acute renal injury in this case suggests the presence of comorbidity, emphasizing the need for prompt action to mitigate the negative consequences of rhabdomyolysis. Awareness and early intervention are crucial in preventing and managing this condition effectively.

Factors associated with extension of the scheduled time for spine surgery

OBJECTIVES

Adherence to scheduled times in surgery is important in hospital management. However, sudden surgical changes or unexpected intraoperative problems may lead to prolongation of operative times. The purpose of this study was to investigate operative times in spinal surgery and to identify causes of delays during surgery.

PATIENTS AND METHODS

A retrospective review of 488 cases of spinal surgery was performed to investigate operations prolonged for >2 h and to identify factors associated with prolongation.

RESULTS

There were 250 cases without a delay, and 144, 64, and 30 with delays of <1 h, 1-2 h, and >2 h, respectively. Delays >2 h were caused by interruptions due to loss of transcranial motor-evoked potential (Tc-MEP) signals in spinal cord monitoring (n = 15), reinsertion due to screw misplacement (n = 5), intraoperative pathology procedures (n = 5), extension of fusion range with instrumentation (n = 3), and complete resection of an intramedullary tumor (n = 2). Surgeries with delays >2 h (n = 30) had greater rates of scheduled surgery for >5 h (40% vs. 23%; P < 0.05), instrumentation use (70% vs. 47%; P < 0.05), reoperation (33% vs. 7%; P < 0.01%), and estimated blood loss (EBL) (1573 vs. 435 ml; P < 0.01), compared to all other surgeries (n = 458). In multivariate logistic regression, reoperation (HR 3.15, 95% CI 1.52-6.55; p < 0.01) and EBL ≥ 1000 ml (HR 3.35, 95% CI 1.56-7.18; p < 0.01) were significantly associated with prolongation of surgery by >2 h.

CONCLUSION

Information suggesting potential prolongation of surgery should be shared with all medical staff. Reliable surgical techniques and hemostasis may also reduce delays in surgery.