Should creatine kinase be routinely measured after bariatric surgery?

Abstract

Background: Rhabdomyolysis (RML) is a postbariatric surgical complication that can lead to fatal outcomes, including acute kidney injury, so it needs an early diagnosis. Aim: To determine whether creatinine kinase (CK) assessment should be routinely measured in high-risk patients after bariatric surgery. Patients and Methods: This study was a single-center, prospective, observational study from January to June 2021. All consecutive patients aged 18 years and above who were candidates for bariatric surgery were recruited and assessed for eligibility. With excluding patients who had previous bariatric surgery, significant long-standing heart/lung disease, or alcohol abuse. Preoperatively, full clinical assessments were done, laboratory tests were done, and on day 1, postoperatively, including creatinine, CK, alanine aminotransferase, aspartate aminotransferase, sodium, potassium, and operative data. The primary outcome was the occurrence of RML, depending mainly on CK level on day 1 postoperative. Results: Postoperative RML was diagnosed in eight (25%) patients with a mean BMI level of 60±4.5, operative duration of 5±1 h, and Creatine phosphokinase (CPK) mean level of 3965±2328. Conclusion: As bariatric surgery volumes rise, clinicians should be ready to quickly identify and treat RML, which occurs in 25% of our patients. CK levels may increase 24 h after bariatric surgery. Higher BMI, diabetes, arterial hypertension, and postoperative CPK levels are risk factors for RML. In our series, aggressive fluid therapy and diuretics prevented acute kidney injury when elevated CK values were detected. We recommend routine CPK monitoring after bariatric surgery.