- Email: [email protected]
Comment on: Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South-Italy
Author's Accepted Manuscript
Paired Editorial to Accompany "Rhabdomyolysis After Bariatric Surgery; A Multicenter, Prospective Study on Incidence, Risk Factors, and Therapeutic Strategy in a Cohort From South-Italy" Robert B. Lim MD, FACS, FASMBS
www.journals.elsevier.com/surgery-for-obesity-and-related-diseases/
PII: DOI: Reference:
S1550-7289(15)01057-6 http://dx.doi.org/10.1016/j.soard.2015.11.017 SOARD2478
To appear in:
Surgery for Obesity and Related Diseases
Cite this article as: Robert B. Lim MD, FACS, FASMBS, Paired Editorial to Accompany "Rhabdomyolysis After Bariatric Surgery; A Multicenter, Prospective Study on Incidence, Risk Factors, and Therapeutic Strategy in a Cohort From South-Italy", Surgery for Obesity and Related Diseases, http://dx.doi.org/10.1016/j.soard.2015.11.017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Paired Editorial to accompany "Rhabdomyolysis after bariatric surgery; a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South-Italy" Robert B. Lim, MD, FACS, FASMBS Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii contact information: Robert Lim, MD Department of Surgery Tripler Army Medical Center 1 Jarrett White Road Honolulu, Hawaii 96859 808 433-4136 (office) 808 433-6539 (FAX) [email protected]
Paired Editorial for SOARD-15-115R6 The authors are to be commended for reporting on an underappreciated and potentially very harmful aspect of bariatric surgical care. Because of the large number of subjects, the prospective and multicenter approach, the standardized approach of anesthesia, and the use of three distinct comparison groups, the authors can claim that their conclusions are the most comprehensive and accurate reports on the incidence of rhabdomyolysis (RML). It appears that in bariatric or obese patients, operations that last longer than 4 hours have a significant increase in the incidence of RML. This appears to be much earlier than the onset of RML in non-obese patients. Because of their findings, any obese patient whose bariatric procedure extends beyond 4 hours should, at least, be screened for RML. For these cases, surgical teams should ask about
Rhabdomyolysis after bariatric surgery
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musculoskeletal pain and order serum creatine kinase (CK) levels to be analyzed routinely at 0 ,12, 24, and 48 hours after the operation. Their results about the treatment of RML are not as definitive, as not every patient with a rise in CK will go on to experiencing full RML. Thankfully their treatment of the rising CK did not appear to negatively affect the patients in anyway suggesting that aggressive treatment of rising CK can prevent RML and relieve pain symptoms without causing other complications. It should be noted that in the historical clinical comparison group of obese patients who underwent a bariatric procedure and whose therapy was started 72 hours post-operation, 7 patients went on to experience an acute kidney injury and 2 even required dialysis. This suggests that therapy to prevent RML should be instituted earlier. More research is needed to clearly identify the appropriate treatment of RML in obese patients; but it is clear that the almost 13% incidence is something that clinicians must be aware of and prepared to treat in bariatric patients who complain of musculoskeletal pain after their operation or whose weight loss procedure lasts longer than 4 hours. Though this study did not examine it, it is my estimation, that the RML incidence is likely to be increased in obese patients undergoing non-bariatric procedures as well; and consequently, any obese patient whose abdominal surgery lasts more than 4 hours should be screened for RML.
Rhabdomyolysis after bariatric surgery
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Paired Editorial to Accompany "Rhabdomyolysis After Bariatric Surgery; A Multicenter, Prospective Study on Incidence, Risk Factors, and Therapeutic Strategy in a Cohort From South-Italy" Robert B. Lim MD, FACS, FASMBS
www.journals.elsevier.com/surgery-for-obesity-and-related-diseases/
PII: DOI: Reference:
S1550-7289(15)01057-6 http://dx.doi.org/10.1016/j.soard.2015.11.017 SOARD2478
To appear in:
Surgery for Obesity and Related Diseases
Cite this article as: Robert B. Lim MD, FACS, FASMBS, Paired Editorial to Accompany "Rhabdomyolysis After Bariatric Surgery; A Multicenter, Prospective Study on Incidence, Risk Factors, and Therapeutic Strategy in a Cohort From South-Italy", Surgery for Obesity and Related Diseases, http://dx.doi.org/10.1016/j.soard.2015.11.017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Paired Editorial to accompany "Rhabdomyolysis after bariatric surgery; a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South-Italy" Robert B. Lim, MD, FACS, FASMBS Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii contact information: Robert Lim, MD Department of Surgery Tripler Army Medical Center 1 Jarrett White Road Honolulu, Hawaii 96859 808 433-4136 (office) 808 433-6539 (FAX) [email protected]
Paired Editorial for SOARD-15-115R6 The authors are to be commended for reporting on an underappreciated and potentially very harmful aspect of bariatric surgical care. Because of the large number of subjects, the prospective and multicenter approach, the standardized approach of anesthesia, and the use of three distinct comparison groups, the authors can claim that their conclusions are the most comprehensive and accurate reports on the incidence of rhabdomyolysis (RML). It appears that in bariatric or obese patients, operations that last longer than 4 hours have a significant increase in the incidence of RML. This appears to be much earlier than the onset of RML in non-obese patients. Because of their findings, any obese patient whose bariatric procedure extends beyond 4 hours should, at least, be screened for RML. For these cases, surgical teams should ask about
Rhabdomyolysis after bariatric surgery
Page 1
musculoskeletal pain and order serum creatine kinase (CK) levels to be analyzed routinely at 0 ,12, 24, and 48 hours after the operation. Their results about the treatment of RML are not as definitive, as not every patient with a rise in CK will go on to experiencing full RML. Thankfully their treatment of the rising CK did not appear to negatively affect the patients in anyway suggesting that aggressive treatment of rising CK can prevent RML and relieve pain symptoms without causing other complications. It should be noted that in the historical clinical comparison group of obese patients who underwent a bariatric procedure and whose therapy was started 72 hours post-operation, 7 patients went on to experience an acute kidney injury and 2 even required dialysis. This suggests that therapy to prevent RML should be instituted earlier. More research is needed to clearly identify the appropriate treatment of RML in obese patients; but it is clear that the almost 13% incidence is something that clinicians must be aware of and prepared to treat in bariatric patients who complain of musculoskeletal pain after their operation or whose weight loss procedure lasts longer than 4 hours. Though this study did not examine it, it is my estimation, that the RML incidence is likely to be increased in obese patients undergoing non-bariatric procedures as well; and consequently, any obese patient whose abdominal surgery lasts more than 4 hours should be screened for RML.
Rhabdomyolysis after bariatric surgery
Page 2