Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy

Background: At present, prospectively collected data on rhabdomyolysis (RML) after bariatric surgery are limited. Objectives: To evaluate the incidence, risk factors, and therapeutic strategy of RML in different bariatric procedures. Setting: 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. Conclusion: 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. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.