Rhabdomyolysis following Nuss Procedure: A Prospective Study in Children

 

 Buy Article Permissions and Reprints

Abstract

Introduction Postoperative rhabdomyolysis (RML) has been documented after several surgical procedures in adults. Musculoskeletal remodeling after Nuss procedure for pectus excavatum (PE) could cause RML. We evaluated the incidence of RML after Nuss procedure in children.

Methods This study was a prospective study from 2018 to 2021. We enrolled all otherwise healthy patients who underwent PE correction with only one bar. Studied variables included demographic and clinical data, duration of surgery, complications, and length of hospitalization. The patients included underwent serial measurements of serum creatine kinase (CK), troponin I, N terminal pro B-type natriuretic peptide (NT-proBNP), serum creatinine, urea, and glomerular filtration rate at 6 and 48 hours postoperatively, and hospital discharge.

Results Forty-six patients met criteria (40 males/6 females), with a mean age of 15.1 ± 1.4 years. Mean duration of surgery was 74 ± 28 minutes, and length of hospitalization was 4.6 ± 1.6 days. RML was diagnosed in 30.4% of patients at 6 hours, 91.3% at 48 hours, and 21.7% at hospital discharge. Mean preoperative CK value was 181.1 ± 141.6 IU/L, and postoperative values were 863.3 ± 302.6 IU/L at 6 hours, 1,675.2 ± 561 IU/L at 48 hours, and 850 ± 683.7 IU/L at hospital discharge, with statistically significant differences (p = 0.001). High-sensitivity troponin I and NT-proBNP levels increased significantly during the postoperative time (p = 0.001). Renal function remained stable (p = 0.55).

Conclusion Nuss technique produces RML without kidney injury in healthy patients. This knowledge should be considered for patients at increased risk of developing acute kidney injury and other complications.

Publication History

Received: 03 June 2022

Accepted: 06 September 2022

Accepted Manuscript online:
08 September 2022

Article published online:
16 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Szugye HS. Pediatric rhabdomyolysis. Pediatr Rev 2020; 41 (06) 265-275
  CrossrefPubMedGoogle Scholar
• 2 Gupta A, Thorson P, Penmatsa KR, Gupta P. Rhabdomyolysis: revisited. Ulster Med J 2021; 90 (02) 61-69
  PubMedGoogle Scholar
• 3 Omar AS, Ewila H, Aboulnaga S, Tuli AK, Singh R. Rhabdomyolysis following cardiac surgery: a prospective, descriptive, single-center study. BioMed Res Int 2016; 2016: 7497936
  PubMedGoogle Scholar
• 4 Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve 2002; 25 (03) 332-347
  CrossrefPubMedGoogle Scholar
• 5 Portella ST, Acioly MA. Rhabdomyolysis and spine surgery: a systematic review of the literature. J Clin Neurosci 2019; 70: 178-182
  CrossrefPubMedGoogle Scholar
• 6 Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg 2013; 23 (08) 1333-1340
  CrossrefPubMedGoogle Scholar
• 7 Pariser JJ, Pearce SM, Patel SG. et al. Rhabdomyolysis after major urologic surgery: epidemiology, risk factors, and outcomes. Urology 2015; 85 (06) 1328-1332
  CrossrefPubMedGoogle Scholar
• 8 Grammer R, Wang J, Lahey E. Rhabdomyolysis after prolonged surgery: report of 2 cases and review of literature. J Oral Maxillofac Surg 2018; 76 (07) 1424-1430
  CrossrefPubMedGoogle Scholar
• 9 Frantz FW. Indications and guidelines for pectus excavatum repair. Curr Opin Pediatr 2011; 23 (04) 486-491
  CrossrefPubMedGoogle Scholar
• 10 Mehta RL, Kellum JA, Shah SV. et al; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (02) R31
  CrossrefPubMedGoogle Scholar
• 11 Reisiger KE, Landman J, Kibel A, Clayman RV. Laparoscopic renal surgery and the risk of rhabdomyolysis: diagnosis and treatment. Urology 2005; 66 (05, Suppl): 29-35
  CrossrefPubMedGoogle Scholar
• 12 Lee KS, Kim HJ, Lee YS. et al. Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study. Braz J Anesthesiol 2021; S0104-0014 (21) 00370-5
  PubMedGoogle Scholar
• 13 Ettinger JEMTM, de Souza CAM, Santos-Filho PV. et al. Rhabdomyolysis: diagnosis and treatment in bariatric surgery. Obes Surg 2007; 17 (04) 525-532
  CrossrefPubMedGoogle Scholar
• 14 de Menezes Ettinger JEMT, dos Santos Filho PV, Azaro E, Melo CA, Fahel E, Batista PB. Prevention of rhabdomyolysis in bariatric surgery. Obes Surg 2005; 15 (06) 874-879
  CrossrefPubMedGoogle Scholar
• 15 Laurence AS. Serum myoglobin and creatine kinase following surgery. Br J Anaesth 2000; 84 (06) 763-766
  CrossrefPubMedGoogle Scholar
• 16 de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BGM, Drenth JPH. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 2003; 29 (07) 1121-1125
  CrossrefPubMedGoogle Scholar
• 17 Veenstra J, Smit WM, Krediet RT, Arisz L. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. Nephrol Dial Transplant 1994; 9 (06) 637-641
  CrossrefPubMedGoogle Scholar
• 18 Mikkelsen TS, Toft P. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand 2005; 49 (06) 859-864
  CrossrefPubMedGoogle Scholar
• 19 Brown CVR, Rhee P, Chan L, Evans K, Demetriades D, Velmahos GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?. J Trauma 2004; 56 (06) 1191-1196
  CrossrefPubMedGoogle Scholar
• 20 El-Abdellati E, Eyselbergs M, Sirimsi H. et al. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care 2013; 3 (01) 8
  CrossrefPubMedGoogle Scholar
• 21 Simpson JP, Taylor A, Sudhan N, Menon DK, Lavinio A. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: a retrospective observational evaluation. Eur J Anaesthesiol 2016; 33 (12) 906-912
  CrossrefPubMedGoogle Scholar
• 22 Deviggiano A, Carrascosa P, Vallejos J. et al. Relationship between cardiac MR compression classification and CT chest wall indexes in patients with pectus excavatum. J Pediatr Surg 2018; 53 (11) 2294-2298
  CrossrefPubMedGoogle Scholar
• 23 Finsterer J, Stöllberger C. Where does troponin I derive from in rhabdomyolysis?. Am J Emerg Med 2006; 24 (04) 509-510 , author reply 510–511
  CrossrefPubMedGoogle Scholar
• 24 Wongrakpanich S, Kallis C, Prasad P. et al. Prevalence of false positive troponin I in elderly patients with rhabdomyolysis. Geriatr Gerontol Int 2017; 17 (07) 1137-1140
  CrossrefPubMedGoogle Scholar
• 25 Li SF, Zapata J, Tillem E. The prevalence of false-positive cardiac troponin I in ED patients with rhabdomyolysis. Am J Emerg Med 2005; 23 (07) 860-863
  CrossrefPubMedGoogle Scholar
• 26 Hall C. NT-ProBNP: the mechanism behind the marker. J Card Fail 2005; 11 (5, Suppl): S81-S83
  CrossrefPubMedGoogle Scholar
• 27 Mognol P, Vignes S, Chosidow D, Marmuse JP. Rhabdomyolysis after laparoscopic bariatric surgery. Obes Surg 2004; 14 (01) 91-94
  CrossrefPubMedGoogle Scholar
• 28 de Freitas Carvalho DA, Valezi AC, de Brito EM, de Souza JC, Masson AC, Matsuo T. Rhabdomyolysis after bariatric surgery. Obes Surg 2006; 16 (06) 740-744
  CrossrefPubMedGoogle Scholar
• 29 Lagandré S, Arnalsteen L, Vallet B. et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg 2006; 16 (10) 1365-1370
  CrossrefPubMedGoogle Scholar
• 30 de Oliveira LD, Diniz MTC, de Fátima H S Diniz M, Savassi-Rocha AL, Camargos ST, Cardoso F. Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study. Obes Surg 2009; 19 (08) 1102-1107
  CrossrefPubMedGoogle Scholar
• 31 Youssef T, Abd-Elaal I, Zakaria G, Hasheesh M. Bariatric surgery: rhabdomyolysis after open Roux-en-Y gastric bypass: a prospective study. Int J Surg 2010; 8 (06) 484-488
  CrossrefPubMedGoogle Scholar
• 32 Wool DB, Lemmens HJM, Brodsky JB, Solomon H, Chong KP, Morton JM. Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients. Obes Surg 2010; 20 (06) 698-701
  CrossrefPubMedGoogle Scholar
• 33 Tolone S, Pilone V, Musella M. et al. Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy. Surg Obes Relat Dis 2016; 12 (02) 384-390
  CrossrefPubMedGoogle Scholar
• 34 Papadakis M, Sapkas G, Tzoutzopoulos A. A rare case of rhabdomyolysis and acute renal failure following spinal surgery. J Neurosurg Spine 2008; 9 (04) 387-389
  CrossrefPubMedGoogle Scholar
• 35 Dakwar E, Rifkin SI, Volcan IJ, Goodrich JA, Uribe JS. Rhabdomyolysis and acute renal failure following minimally invasive spine surgery: report of 5 cases. J Neurosurg Spine 2011; 14 (06) 785-788
  CrossrefPubMedGoogle Scholar
• 36 Makler V, Norregaard TV. Rhabdomyolysis following minimally invasive transforaminal lumbar interbody fusion: case report. Surg Neurol Int 2018; 9: 50
  CrossrefPubMedGoogle Scholar