title: Rhabdomyolysis in bariatric surgery: a systematic review.
abstract: BACKGROUND
  Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML.
  
  
  METHODS
  A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. RML was defined as a creatine kinase of more than 1,000 IU/L. The parameters assessed included patient characteristics of the RML population, type of bariatric surgery performed, operating time, complications, presentation and diagnosis of RML.
  
  
  RESULTS
  Twenty-two studies were analysed which included 11 case reports, two case series, six prospective and three retrospective comparative studies. Overall 145 patients with RML were reported following bariatric surgery. Acute renal failure was found in 20 patients (14 %) and was significantly more likely to occur in patients with postoperative muscle pain (p < 0.05). The mortality rate after renal failure was 25 % (n = 5). In the comparative studies, 87 RML patients were compared with 325 non-RML patients. The RML patients were more likely to be male, had a greater mean body mass index (BMI) (52 vs 48 kg/m(2), p < 0.01) and underwent a longer operation (255 vs 207 min, p < 0.01) compared to non-RML patients.
  
  
  CONCLUSIONS
  Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly.
authors.affiliation: Department of Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chakravartty
authors.forename: Diwakar R
authors.initials: DR
authors.lastname: Sarma
authors.forename: Ameet G
authors.initials: AG
authors.lastname: Patel
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D063806:Myalgia / Q000097:blood* / Q000209:etiology; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D018579:Patient Selection; D011184:Postoperative Period; D012206:Rhabdomyolysis / Q000097:blood / Q000209:etiology; D012307:Risk Factors; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003402:Creatine Kinase
references.citation: Am J Med. 2012 Dec;125(12):1195-1204.e3
references.pmid: 23062398
references.citation: Obes Surg. 2006 Oct;16(10):1365-70
references.pmid: 17059748
references.citation: Obes Surg. 2003 Apr;13(2):306-13
references.pmid: 12740145
references.citation: Eur J Intern Med. 2012 Jun;23(4):317-24
references.pmid: 22560377
references.citation: Am J Nephrol. 1991;11(6):447-50
references.pmid: 1819210
references.citation: JSLS. 2007 Oct-Dec;11(4):432-7
references.pmid: 18237506
references.citation: Muscle Nerve. 2002 Mar;25(3):332-47
references.pmid: 11870710
references.citation: Arch Surg. 2004 Jan;139(1):73-6
references.pmid: 14718280
references.citation: Neurologia. 2005 Mar;20(2):94-7
references.pmid: 15726478
references.citation: Obes Surg. 2005 Oct;15(9):1347-51
references.pmid: 16259902
references.citation: Obes Surg. 2003 Apr;13(2):297-301
references.pmid: 12740143
references.citation: Obes Surg. 2008 Jun;18(6):635-43
references.pmid: 18373125
references.citation: Obes Surg. 2006 Sep;16(9):1209-13
references.pmid: 16989706
references.citation: J Am Coll Cardiol. 2010 Sep 28;56(14):1099-109
references.pmid: 20825761
references.citation: Obes Surg. 2006 Jun;16(6):740-4
references.pmid: 16756735
references.citation: Obes Surg. 2010 Jun;20(6):698-701
references.pmid: 20198451
references.citation: Am J Cardiol. 2005 Mar 1;95(5):658-60
references.pmid: 15721114
references.citation: J Am Coll Surg. 1998 Jun;186(6):693-716
references.pmid: 9632160
references.citation: Obes Surg. 2007 Apr;17(4):525-32
references.pmid: 17608266
references.citation: Urology. 1996 Mar;47(3):427-30
references.pmid: 8633416
references.citation: Obes Surg. 2004 Jan;14(1):91-4
references.pmid: 14980040
references.citation: Rev Bras Anestesiol. 2006 Aug;56(4):408-12
references.pmid: 19468586
references.citation: Br J Anaesth. 2009 Feb;102(2):283-4
references.pmid: 19151057
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: J Neurosurg Spine. 2011 Jun;14(6):785-8
references.pmid: 21417696
references.citation: J Bone Joint Surg Br. 1991 Jul;73(4):576-9
references.pmid: 2071638
references.citation: Lipids Health Dis. 2011 Nov 07;10:201
references.pmid: 22059738
references.citation: Neth J Med. 2009 Oct;67(9):272-83
references.pmid: 19841484
references.citation: Eur J Anaesthesiol. 2007 Jun;24(6):551-5
references.pmid: 17241501
references.citation: Obes Surg. 2008 Mar;18(3):349-51
references.pmid: 18193179
references.citation: Rev Bras Anestesiol. 2006 Feb;56(1):63-71
references.pmid: 19468552
references.citation: Int J Surg. 2010;8(6):484-8
references.pmid: 20624497
references.citation: Obes Surg. 2003 Dec;13(6):941-3
references.pmid: 14738687
references.citation: Arch Intern Med. 1988 Jul;148(7):1553-7
references.pmid: 3382301
references.citation: Obes Surg. 2005 Mar;15(3):428-30
references.pmid: 15826481
references.citation: Ann Emerg Med. 1994 Jun;23(6):1301-6
references.pmid: 8198305
references.citation: Am Surg. 1997 Apr;63(4):361-4
references.pmid: 9124760
references.citation: Obes Surg. 2009 Aug;19(8):1102-7
references.pmid: 19096900
references.citation: Br Med J. 1941 Mar 22;1(4185):427-32
references.pmid: 20783577
references.citation: J Neuroimaging. 1999 Jul;9(3):182-4
references.pmid: 10436762
references.citation: JRSM Short Rep. 2012 Mar;3(3):16
references.pmid: 22479679
references.citation: Obes Surg. 2003 Apr;13(2):302-5
references.pmid: 12740144
references.citation: Obes Surg. 2005 Nov-Dec;15(10):1496-500
references.pmid: 16354534
references.citation: Nat Rev Nephrol. 2011 May 17;7(7):416-22
references.pmid: 21587227
references.citation: Arch Intern Med. 1984 Feb;144(2):277-80
references.pmid: 6696564