title: Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy.
abstract: BACKGROUND
  At present, prospectively collected data on rhabdomyolysis (RML) after bariatric surgery are limited.
  
  
  OBJECTIVE
  To evaluate the incidence, risk factors, and therapeutic strategy of RML in different bariatric procedures.
  
  
  METHODS
  University hospitals, Italy.
  
  
  METHODS
  Obese patients were prospectively enrolled. Preoperative demographic characteristics and clinical data, as well as type of anesthesia and type and total duration of surgery, were recorded as potential risk factors for RML. RML was defined as postoperative creatine kinase (CK)>1000 U/L. Incidence, possible risk factors, and therapeutic outcome of RML were assessed and compared with comparative groups.
  
  
  RESULTS
  Four hundred eighty obese patients were included in the study. After surgery, RML was diagnosed in 62 (12.9%) patients. Muscular pain was present in 12 patients (19.3%). In RML patients, mean CK value was 1346±2132.5 U/L (range 1191-37,400). Only duration of surgery was identified as an independent risk factor for RML (P<.001). The best cutoff value of time as a predictor was 230 minutes. Aggressive therapy with fluids and diuretics started within 24 hours after surgery was more effective in relieving RML and muscle pain than a comparative retrospective group with a delayed diagnosis and therapy.
  
  
  CONCLUSIONS
  After bariatric surgery, the risk of RML increases, especially when the duration of surgery is>230 minutes. CK testing should be performed in all patients after bariatric surgery to make an early diagnosis and properly start fluids and diuretics.
authors.affiliation: Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy. Electronic address: salvatore.tolone@unina2.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Bariatric and Metabolic Surgery Unit, University of Salerno, Salerno, Italy; Division of General, Oncological and Bariatric Surgery, Federico II University of Naples, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pilone
authors.affiliation: Division of Video-assisted Gastric Surgery, Federico II University of Naples, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.affiliation: Division of Gastrointestinal Surgical Pathophysiology, Second University of Naples, Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.affiliation: Division of Video-assisted Gastric Surgery, Federico II University of Naples, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.affiliation: Division of Gastrointestinal Surgical Pathophysiology, Second University of Naples, Naples, Italy.
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.affiliation: Division of Gastrointestinal Surgical Pathophysiology, Second University of Naples, Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
authors.affiliation: Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors
keywords: Bariatric Surgery; Obesity; Rhabdomyolysis