Rhabdomyolysis after Gastric Bypass: Severity and Outcome Patterns |
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Authors: | Joel Faintuch MD PhD Roberto de Cleva MD Denis Pajecki MD Arthur B Garrido Jr MD Ivan Cecconello MD |
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Affiliation: | 1. Division of Gastrointestinal Surgery, Hospital das Clínicas and S?o Paulo University Medical School, S?o Paulo, Brazil 2. Surgical Intensive Care Unit, Department of Gastroenterology, Hospital das Clínicas and S?o Paulo University Medical School, S?o Paulo, Brazil 3. Outpatient Clinic of Obesity Surgery Group, Hospital das Clínicas and S?o Paulo University Medical School, S?o Paulo, Brazil 4. Obesity Surgery Group, Hospital das Clínicas and S?o Paulo University Medical School, S?o Paulo, Brazil 5. Division of Gastrointestinal Surgery, Hospital das Clínicas and S?o Paulo University Medical School, S?o Paulo, Brazil
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Abstract: | Background: Rhabdomyolysis (RML) is a recently recognized complication of bariatric operations, but it is not known whether creatine kinase (CK) levels along with clinical markers are able to define the course and outcome. Methods: Bariatric patients (n=324) were reviewed retrospectively. Substantially elevated plasma CK after operation was identified in 4.9% (16/324). The affected population was divided into Group I (n=11, 68.8%) with CK 1050-8000 IU/L and no conspicuous muscle pain, weakness or swelling, and Group II (n=5, 31.2%) displaying CK >8000 IU/L and severe pain and dysfunction. The main outcome measures were CK concentration, frequency of renal failure, need for hemodialysis and mortality. Results: Group I subjects compared to Group II were younger (37.7 ± 10.9 vs 44.0 ± 5.5 years, P<0.05) and predominantly females (72.7% vs 40.0%, P<0.05). Peak CK values were definitely lower (2811 ± 952 vs 28136 ± 19000 IU/L, P<0.001), and none progressed to renal failure (0% vs 40.0%, P<0.05). No difference was detected regarding preoperative BMI (50.8 ± 8.1 vs 54.6 ± 7.0 kg/m2, NS), duration of operation (5.3 ± 1.6 vs 5.6 ± 2.1 hours, NS) or types of anesthetic drugs (basically fentanyl, nitrogen oxide and halothane/isoflurane). Conclusions: 1) Demographic features, nominally gender and age, were different between the two degrees of RML; 2) Renal failure and hemodialysis were a danger only in patients with massive CK elevation and muscle pain; 3) Moderate CK increase was very well tolerated and rarely entailed major clinical symptoms; 4) Early diagnosis, fluid replenishment and general supportive therapy probably contributed to avert mortality. |
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Keywords: | RHABDOMYOLYSIS MORBID OBESITY BARIATRIC SURGERY GASTRIC BYPASS RENAL FAILURE HEMODIALYSIS |
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