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Hypocalcemia in the Immediate Postoperative Period Following Metabolic Bariatric Surgery – Hype or Harm?

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Abstract

Purpose

Hypocalcemia post-metabolic bariatric surgery (MBS) is a known long-term complication after hypoabsorptive procedures. However, data on immediate postoperative calcium are limited. Our aim was to evaluate the prevalence of hypocalcemia on the 1st postoperative day after MBS and correlate it with potential associated factors.

Materials and Methods

We analyzed data from all consecutive index MBS over 1 year. We collected data on demographics and on preoperative and postoperative values of serum calcium (TC), albumin, adjusted calcium (AC–Payne formula), magnesium, phosphorus, preoperative vitamin-D, and postoperative 24-h urine output, intravenous fluids (IVF), bolus intravenous furosemide, and creatine phosphokinase (CPK). Continuous data are expressed as means ± SD (range). Categorical data are presented as frequencies (%). Linear regression was implemented to designate potential correlations.

Results

The cohort included 86 patients (58.1% females). The mean preoperative TC was 9.4mg/dL ± 0.4 (8.5–10.5) and mean postoperative TC 7.8mg/dL ± 0.6 (6.3–9.3, 17.0% decrease). The mean preoperative AC was 10.1mg/dL ± 0.4 (9.2–11.2) and mean postoperative AC 8.5mg/dL ± 0.6 (7.0–10.0, 15.8% decrease). Seventy-three patients (84.8%) had abnormally low TC (< 8.5mg/dL), and 43 (50%) abnormally low AC. There was only weak correlation between postoperative TC and AC with magnesium (r = 0.258), phosphorus (r = 0.269), vitamin-D (-0.163), 24-h urine output (r = -0.168), IVF (r = -0.237), bolus furosemide (r = 0.155), and mean operative time (r = 0.010).

Conclusions

In our cohort of patients, hypocalcemia was a real problem but we did not find any significant correlation with the examined factors. Further studies are warranted to validate our findings and investigate other potential correlations.

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Data Availability

Data available upon reasonable request.

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Funding

The authors declare that they received no funding to undertake the present study.

Author information

Authors and Affiliations

  1. 4th Department of General Surgery, Evaggelismos General Hospital of Athens, Ipsilantou 45-47, 106 76, Athens, Greece

    Stefanos Koffas

  2. Obesity and Metabolic Disorders Surgical Department, Athens Medical Group Psychiko Clinic, 1 Andersen Str., 115 25, Athens, Greece

    Athanasios G. Pantelis & Dimitris P. Lapatsanis

Authors
  1. Stefanos Koffas
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  2. Athanasios G. Pantelis
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  3. Dimitris P. Lapatsanis
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Corresponding author

Correspondence to Athanasios G. Pantelis.

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Ethical Approval

For this type of study (retrospective) formal consent is not required.

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Conflicts of Interest

Stefanos Koffas declares that he has no conflict of interest.

Athanasios G. Pantelis declares that he has no conflict of interest.

Dimitris P. Lapatsanis declares that he has no conflict of interest.

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Key points

• Hypocalcemia in the immediate postoperative period following metabolic bariatric surgery was a real problem in our post-bariatric cohort, affecting 84.8% of patients according to total calcium and 50% of patients according to adjusted calcium.

• We observed a mean reduction of 17% in total calcium as compared to preoperative levels, whereas the respective numbers were 17.4% for albumin, 15.8% for adjusted calcium, 15% for magnesium, 20.6% for phosphorus, and 25% for creatinine.

• Single linear regression could not yield any significant correlation between the observed hypocalcemia and other potentially associated factors, including vitamin D, magnesium, phosphorus, urine output, intravenous fluids, and bolus furosemide.

• Further research is warranted to validate our results and investigate other potential associations, such as acid-base status and parathormone levels.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PNG 52 KB) Linear regression plots correlating total calcium with magnesium (A).

Supplementary file2 (PNG 64 KB) Linear regression plots correlating total calcium with phosphorus (B).

Supplementary file3 (PNG 47 KB) Linear regression plots correlating total calcium with vitamin D (C).

Supplementary file4 (PNG 60 KB) Linear regression plots correlating total calcium with 24-hour urine output (D).

Supplementary file5 (PNG 54 KB) Linear regression plots correlating total calcium with intravenous fluids (E).

11695_2024_7312_MOESM6_ESM.png

Supplementary file6 (PNG 53 KB) Linear regression plots correlating total calcium with bolus intravenous furosemide (F).

Supplementary file7 (PNG 59 KB) Linear regression plots correlating adjusted calcium with magnesium (A).

Supplementary file8 (PNG 46 KB) Linear regression plots correlating adjusted calcium with phosphorus (B).

Supplementary file9 (PNG 60 KB) Linear regression plots correlating adjusted calcium with vitamin D (C).

Supplementary file10 (PNG 56 KB) Linear regression plots correlating adjusted calcium with 24-hour urine output (D).

Supplementary file11 (PNG 52 KB) Linear regression plots correlating adjusted calcium withintravenous fluids (E).

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Koffas, S., Pantelis, A.G. & Lapatsanis, D.P. Hypocalcemia in the Immediate Postoperative Period Following Metabolic Bariatric Surgery – Hype or Harm?. OBES SURG 34, 2530–2536 (2024). https://doi.org/10.1007/s11695-024-07312-3

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