Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients

Tinning, C; Cochrane, Lindy; Singer, Brian

doi:10.1016/j.injury.2015.03.035

Cited by 24 publications

(13 citation statements)

References 23 publications

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“…This growing body of evidence highlights the potential systemic negative implications of chronic hyponatremia and raises the question about whether the central nervous system is the main, and perhaps only, end-organ target of systemic hyponatremia ( 19 ). Several studies have reported that hyponatremia is highly prevalent in patients undergoing surgical repair of a traumatic hip fracture, ( 13 , 14 , 20 , 21 ) and this study similarly found that nearly one in four patients (23%) had hyponatremia at the time of hip fracture repair. While these studies have suggested excess short- and long-term mortality in those with hyponatremia, none characterized the duration of hyponatremia and its association with outcomes following hip fracture surgery.…”

Section: Discussionsupporting

confidence: 74%

Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair

Ayus

Fuentes

et al. 2020

Front. Med.

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Background: Chronic hyponatremia is a risk factor for hip fracture but remains uncorrected in most patients. This study evaluated if preoperative chronicity of uncorrected hyponatremia influences outcomes after hip fracture repair. Materials and Methods: Evaluated were older patients hospitalized for hip fracture repair between 2007 and 2012 with plasma sodium measured at admission and ≥1 preadmission outpatient measurement. Patients were classified as being normonatremic (NN; plasma sodium 135–145 mmol/L), chronic prolonged hyponatremia (CPH; ≥2 consecutive plasma sodium values <135 mmol/L over >90 days), or recent hyponatremia (one plasma sodium <135 mmol/L within 30 days before admission with previously normal plasma sodium). Length of hospital stay, in-hospital death, post-operative complications, 30-day readmission, and long-term mortality were the evaluated outcomes. Multivariable Cox regression was used to evaluate the association of hyponatremia status with outcomes. Results: Among 1,571 eligible patients, 76.7% were NN, 14% had CPH, and 9.1% had RH. Compared with NN patients, CHN patients were older and had more prior heart failure, alcoholism, and anticonvulsant drug use. In multivariable analyses, neither CPH or RH was associated with hospital length of stay, in-hospital or 30-day death, or 30-day readmission, while RH was associated with post-operative sepsis [adjusted odds ratio (aOR) 1.84, 95% CI: 1.01–3.35). Only CPH was independently associated with long-term all-cause death (OR 1.53, 95% CI: 1.12–2.09). Conclusions: Hyponatremia affects nearly 25% of patients undergoing hip fracture repair. Preoperative chronic untreated hyponatremia is associated with increased post-operative mortality following surgical repair of a hip fracture in older patients. Future studies should evaluate if correction of hyponatremia could decrease long-term mortality after hip fracture repair.

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Section: Discussionsupporting

confidence: 74%

Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair

Ayus

Fuentes

et al. 2020

Front. Med.

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“…Multiple studies have investigated patient baseline conditions and concluded positive association between postoperative mortality and laboratory parameters such as hyponatraemia, 12,13,43 anemia, 44,45 basal hemoglobin level, 11 level of albumin, 38,46 level of CRP, and total lymphocyte count. 10 Aside from the question if patients died from or with these conditions, 13,14 most of these studies are retrospective studies and heterogeneity in the patient population is assumed.…”

Section: Discussionmentioning

confidence: 99%

“…It has been pointed out that surgery delay may be justified under conditions when preoperative optimization (eg, to correct anemia or electrolyte imbalance) could improve the outcome. 7 –9 However, several recent studies pointing to an association between excessive mortality and laboratory results such as hyponatremia and low hemoglobin count 10 –12 led to the criticism that these conditions are simply markers of other underlying diseases, and they may or may not be risk factors associated mortality on their own. 7,13,14…”

Section: Introductionmentioning

confidence: 99%

Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series

Belangero

Barla

Bergalli³

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction:Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality.Patients and Methods:Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests.Results:Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (≥85 years old, P = .032), existing comorbidity (P = .002), preinjury mobility level (P = .026), mental state (Mini-Mental State Examination > 23, P = .040), low preoperative plasma albumin level (P = .007), and high preoperative blood C-reactive protein level (CRP; P = .012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury.Discussion:As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation.Conclusion:The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate.

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“…After trauma and uncomplicated surgery, a delicate balance between pro‐ and anti‐inflammatory mediators is observed . Other changes associated with trauma are decreased red blood cell parameters, trauma‐induced coagulopathies, and abnormal blood glucose and electrolytes . In patients with general trauma, hematuria is a frequent finding when blunt renal injury has occurred …”

Section: Introductionmentioning

confidence: 99%

Changes in admission laboratory tests in patients with maxillofacial fractures and the influence of dento‐alveolar trauma

Rodrigues

Leite‐de‐Lima

Landes³

et al. 2020

Dental Traumatology

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Background/Aim: There are few studies in the literature evaluating possible alterations in laboratory tests in patients with maxillofacial fractures. The aim of this study was to analyze the changes in admission laboratory tests of patients with maxillofacial fractures with indications for surgical treatment, including the influence of dento-alveolar trauma.Material and Methods: Data from complete blood counts, blood coagulation tests, blood chemistries, and urinalysis results were obtained. The occurrence of concomitant dento-alveolar trauma was noted. The medical records were also re-evaluated later to verify the treatment outcome and the occurrence of complications. Statistical analyses were performed using the likelihood-ratio test to verify significant changes in the evaluated parameters (P ≤ .050). Results:There was a prevalence of males (78%) with a mean age of 35.9 years. Lower erythrocyte counts, hemoglobin levels, and/or hematocrit were observed in males with associated fractures and with simultaneous dento-alveolar fractures. Higher mean neutrophil, segmented neutrophil, and lymphocyte counts were observed in patients with simultaneous dento-alveolar trauma. A higher mean activated partial thromboplastin time (aPTT) ratio was also observed. Lower potassium levels were observed for patients in the fourth decade of life. Higher leukocyte counts not associated with trauma were observed in the urinalysis results of females and in the group of patients aged 20 or younger. Verification of treatment outcome showed two cases of infections and two cases that needed re-operation after mandible fractures.These four cases showed no significant changes in laboratory tests regarding the predisposition for complications. Conclusion:Patients with maxillofacial fractures had neutrophilia, increased aPTT, and non-traumatic leukocyturia. There was an influence of associated fractures and dento-alveolar trauma on the decrease in red blood cell parameters, neutrophilia, and lymphocytosis and of age on hypokalemia. K E Y W O R D Sblood cell count, blood coagulation tests, chemistry, clinical, dento-alveolar trauma, maxillofacial injuries, urinalysis

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Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients

Cited by 24 publications

References 23 publications

Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair

Chronicity of Uncorrected Hyponatremia and Clinical Outcomes in Older Patients Undergoing Hip Fracture Repair

Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series

Changes in admission laboratory tests in patients with maxillofacial fractures and the influence of dento‐alveolar trauma

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