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Rhabdomyolysis following Nuss Procedure: A Prospective Study in Children
Karla Estefanía1, Javier Serradilla1, Carla Ramirez1
1Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Summary
The Nuss procedure for pectus excavatum can cause rhabdomyolysis (muscle breakdown) in children. However, kidney function remains stable after this surgery.
Area of Science:
- Pediatric Surgery
- Cardiothoracic Surgery
- Nephrology
Background:
- Postoperative rhabdomyolysis (RML) is a known complication following various surgical procedures in adults.
- The Nuss procedure for pectus excavatum involves significant musculoskeletal remodeling, potentially leading to RML.
- The incidence and impact of RML after the Nuss procedure in pediatric patients remain under-investigated.
Purpose of the Study:
- To evaluate the incidence of postoperative rhabdomyolysis (RML) in children undergoing the Nuss procedure for pectus excavatum (PE).
- To assess the associated changes in cardiac biomarkers and renal function following the Nuss procedure.
- To determine the clinical significance of RML in this pediatric population.
Main Methods:
- A prospective study was conducted from 2018 to 2021, enrolling otherwise healthy pediatric patients undergoing Nuss procedure for PE.
- Serial measurements of serum creatine kinase (CK), troponin I, NT-proBNP, creatinine, urea, and glomerular filtration rate were performed at 6 and 48 hours postoperatively and at discharge.
- Demographic data, surgical duration, complications, and hospitalization length were recorded.
Main Results:
- Rhabdomyolysis (RML) was diagnosed in a significant percentage of patients: 30.4% at 6 hours, 91.3% at 48 hours, and 21.7% at discharge.
- Postoperative serum creatine kinase (CK) levels showed a statistically significant increase (p=0.001) compared to preoperative values.
- High-sensitivity troponin I and NT-proBNP levels also increased significantly postoperatively (p=0.001), while renal function remained stable (p=0.55).
Conclusions:
- The Nuss procedure in pediatric patients is associated with a high incidence of rhabdomyolysis (RML).
- Despite elevated muscle and cardiac biomarkers, renal function is preserved in otherwise healthy children following the Nuss procedure.
- These findings are crucial for managing patients at risk for acute kidney injury and other postoperative complications.
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