Rhabdomyolysis after bariatric surgery.
BACKGROUND
Rhabdomyolysis is a potential threat after bariatric surgey. The severity ranges from asymptomatic elevations of serum muscle enzyme levels to life-threatening cases associated with muscle necrosis, compartment syndrome, acute renal failure and cardiac arrest.


METHODS
We studied 98 consecutive obese patients who underwent primary uncomplicated bariatric surgery during a 1-year period. A database was created for all patients (sex, age, BMI, duration of the operation); serum creatinine phosphokinase (CPK) was systematically measured before surgery and on the first and second postoperative day.


RESULTS
The study sample consisted of 35 males (35.7%) and 63 females (64.3%) with preoperative CPK level 156.6 +/- 41.1 U/L (40 to 220), 24 hours postoperatively 1,075.2 +/- 596.5 U/L, (85 to 2,790 U/L) and 48 hours postoperatively 967.3 +/- 545.3 U/L (79 to 2,630). There was no difference in mean BMI (P=0.1) and mean duration of operation (P=0.5) between males and females. However, a statistically significant difference in mean elevation of CPK between males and females (P=0.003) was found. The variables sex, age, weight and duration of surgery were analyzed by multivariate logistic regression, but did not show a statistically significant difference.


CONCLUSIONS
Rhabdomyolysis is a potentially fatal complication of surgical procedures in obese patients, and can be minimized with simple measures such as additional padding, aggressive hydration and urine alkalinization. Diagnosis requires a high level of physician awareness.
de Freitas Carvalho
Décio Alexandre
DA
Department of Surgery, Londrina State University, Londrina, Brazil. carvalhodecio@uol.com.br
Valezi
Antonio Carlos
AC
de Brito
Edvaldo Macedo
EM
de Souza
José Carlos Lacerda
JC
Masson
Antonio César
AC
Matsuo
Tiemi
T
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012206:Rhabdomyolysis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors
D003402:Creatine Kinase