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Obesity Surgery
Published in: Obesity Surgery 11/2017

01-11-2017 | Original Contributions

Hypocalcemia After Bariatric Surgery: Prevalence and Associated Risk Factors

Authors: Meera Shah, Anu Sharma, Robert A. Wermers, Kurt A. Kennel, Todd A. Kellogg, Manpreet S. Mundi

Published in: Obesity Surgery | Issue 11/2017

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Abstract

Background

The reported prevalence of hypocalcemia after bariatric surgery ranges from 1% after Roux-en-Y gastric bypass (RYGB) to 25% after bilio-pancreatic diversion-duodenal switch (BPD-DS).

Objective

We aimed to define the prevalence of post-operative hypocalcemia and identify clinical predisposing factors.

Setting

The study was conducted in an Academic Medical Center, USA.

Methods

Retrospective analysis of all patients undergoing bariatric surgery from May 2008 to December 2014 at Mayo Clinic Rochester, Minnesota was performed. Patients with revision surgeries were excluded. Hypocalcemia was defined as the lowest recorded serum calcium occurring at least 2 weeks post-operatively.

Results

Nine hundred ninety-nine patients fulfilled the criteria above. After correction for serum albumin concentration, 36 patients had serum calcium ≤8.9 mg/dl. Mean serum calcium was 8.1 ± 0.6 mg/dl. The prevalence was 1.9% in the RYGB group, 9.3% in the sleeve gastrectomy (SG) group, and 10% in the BPD-DS group.
In all three surgical types, patients with hypocalcemia had significantly lower serum albumin and serum 25 (OH) vitamin D concentrations when compared to their normocalcemic counterparts (P < 0.01). The presence of renal insufficiency and vitamin D deficiency was associated with the highest risk of developing hypocalcemia after surgery [OR 16.8 (6.45–47.7) and 7.1(2.9–17.3), respectively]. Pre-operative renal insufficiency increased the odds of developing hypocalcemia by 20-fold.

Conclusions

In our series, hypocalcemia was identified in 3.6% of patients undergoing all bariatric surgery. Patients who are predisposed to developing post-operative hypocalcemia, such as those with pre-operative renal impairment, or post-operative vitamin D deficiency and renal insufficiency, may benefit from increased surveillance and prevention strategies.
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Metadata
Title
Hypocalcemia After Bariatric Surgery: Prevalence and Associated Risk Factors
Authors
Meera Shah
Anu Sharma
Robert A. Wermers
Kurt A. Kennel
Todd A. Kellogg
Manpreet S. Mundi
Publication date
01-11-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2705-7

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