Electrolyte imbalance after total joint arthroplasty: risk factors and impact on length of hospital stay

Mukartihal, Ravikumar; Puranik, Harish; Patil, Shruti Shrikant; Dhanasekaran, Soundar Rajan; Menon, K. Venugopal

doi:10.1007/s00590-019-02471-x

Cited by 10 publications

(14 citation statements)

References 32 publications

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“…Patients who underwent TKA were at a high risk of electrolyte disorder due to electrolyte loss (up to 83%) 21 , 22 . Furthermore, the metabolic stress evoked by surgeries will decompose body nutrients and cause patients to more easily develop acute malnutrition (up to 49%) 23 .…”

Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Tang

Ning

et al. 2022

Orthopaedic Surgery

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Objective Patients undergoing total knee arthroplasty (TKA) were primarily geriatric, with high risk of postoperative electrolyte disorders and malnutrition. Randomized controlled trials regarding oral nutrition supplement (ONS) strategies in TKA was sparse. This study aimed to evaluate the efficacy of preoperative oral electrolyte‐carbohydrate nutrition supplement (OECNS) on patients (aged >65 years) undergoing TKA. Methods From April 2019 to January 2020, 94 patients undergoing primary elective unilateral TKA in our hospital were considered in this prospective randomized controlled study. This study included patients aged over 65 years with ASA I‐III, and excluded patients with electrolyte disorders, malnutrition, and comorbidities. The control group (control group) received meal nutrition supplements (preoperative 6 h [Pre 6h]) and water (Pre 2h), while OECNS group (intervention group) received meal nutrition supplements (Pre 6h) and OECNS (Pre 2). The Student's t test and χ2 test was used. The primary outcomes were the patient‐reported comfort indicators (PRCIs) including hunger, thirst, nausea, vomiting, weakness, pain, anxiety, and general comfort. The secondary outcomes included indicators of electrolyte, nutrition, functional scores, clinical results, and complications. Results The scores of preoperative hunger (0.43 ± 0.10), pain (2.30 ± 0.34), and anxiety (9.04 ± 2.71) were significantly lower in OECNS group compared with control group (hunger, 1.19 ± 0.21; pain, 3.79 ± 0.26; anxiety, 11.21 ± 3.02) (Pre 1h) (all p < 0.05) as well as the weakness score on the first postoperative day (POD1) (OECNS group 3.57 ± 0.24; control group 5.15 ± 0.29; p < 0.001). A higher level of Na + (OECNS group 140.54 ± 3.39; control group 138.07 ± 5.21; p = 0.008) and a reduced rate of hyponatremia (OECNS group 6.4%; control group 21.3%; p = 0.036) on POD1 were found. Moreover, the higher level of blood glucose (Post 2h) and reduced rates of abnormal blood glucose (Pre 2h, Post 6h) were verified in control group (all p < 0.05). There was no significant difference regarding the other outcomes. Conclusion The administration of OECNS significantly improved subjective comfort, electrolytes, and blood glucose without increasing the rates of complications in patients (aged over 65 years) undergoing TKA.

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Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Tang

Ning

et al. 2022

Orthopaedic Surgery

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“…Reports have indicated imbalances in other vital electrolytes, citing shifts in Mg 2+ , Ca 2+ , Na + , and K + levels following surgery. 28-30 Significant drops in these electrolyte levels may also serve as indicators for complications, as electrolyte depletion has been posed as a potential explanation for the high risk of tachyarrhythmia and other complications in patients following cardiac surgery. 28,31 Furthermore, a retrospective case analysis conducted on a patient cohort of 999 patients demonstrated that hypocalcemia, hypokalemia, and hyponatremia appeared at relatively high incidence rates in patients undergoing gastrointestinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Implications of Postpancreatectomy Hypophosphatemia

Wong

White

Tozzi

et al. 2020

The American Surgeon™

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Background Electrolyte abnormalities are commonly found after major abdominal surgery for malignancy. We hypothesized that the severity of hypophosphatemia developed in pancreatectomy patients would be associated with the incidence of complications postoperatively. Methods A retrospective analysis of an institutional database was conducted for all pancreatic resections (2009-2017). Patient charts were reviewed for demographics, clinicopathologic factors, and perioperative outcomes. Results In a cohort of 283 pancreatectomy patients, 107 (37.8%) and 134 (47.3%) developed mild (2.0-2.5 mg/dL) and moderate/severe hypophosphatemia (<2.0 mg/dL), respectively. Nadir serum phosphate levels were shown to occur on postoperative day (POD) 2 for patients without complications and POD3 for patients who had at least 1 complication. Patients who developed severe hypophosphatemia were significantly more likely to suffer fistula-related complications ( P = .0401). Conclusions Assessing the severity and timing of postpancreatectomy hypophosphatemia presents an opportunity for early detection of impending fistula-related complications.

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“… 1 The undesirable high rates of fluid disturbances in hip surgery mirror this hesitation. 2 - 4 We know that the extent of pre-existing conditions 5 or their chronicity 6 is an important forecaster for a fraction of postoperative events like hyponatremia. However, in the current era of perioperative medicine where everything should be enclosed by recommendations, each blind spot undermines the efficiency of the system, and it is thus time to recall the concept behind fluid administration.…”

Section: Introductionmentioning

confidence: 99%

Oral Hydration Before and After Hip Replacement: The Notion Behind Every Action

Briguglio

Wainwright

Crespi

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction Even though nearly 20 patients undergo hip replacement every hour just in Italy and the United Kingdom, it is unclear what are the most appropriate oral hydration practices that patients should follow before and after surgery. Improper administration can cause postoperative fluid disturbances or exacerbate pre-existing conditions, which are not an uncommon find in older subjects. Significance Considering that the number of hip operations is expected to increase in the next years as well as the age of patients, it is important to recall the notions behind water balance, especially in light of modern surgical and anesthetic practices. This technical perspective discusses the perioperative changes in the hydration status that occur during hip replacement and provides the concepts that help clinicians to better manage how much water the patient can drink. Results The points of view of the surgeon, the anesthetist, and the nurse are offered together with the description of mineral waters intended for human consumption. Before surgery, water should be always preferred over caffeinated, sugar-sweetened, and alcoholic beverages. The drinking requirements on the day of surgery should consider the water output from urine, feces, respiration, exudation, and bleeding along with the water input from metabolic production and intravenous administration of fluids and medications. Healthy eating habits provide water and should be promoted before and after surgery. Conclusions The judgment on which is the most appropriate approach to oral hydration practices must be the responsibility of the multidisciplinary perioperative team. Nevertheless, it is reasonable to argue that, in the presence of a patient with no relevant illness and who follows a healthy diet, it is more appropriate to stay closer to dehydration than liberalizing water intake both prior to surgery and in the early postoperative hours until the resumption of normal physiological functions.

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Electrolyte imbalance after total joint arthroplasty: risk factors and impact on length of hospital stay

Cited by 10 publications

References 32 publications

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Effects of Preoperative Oral Electrolyte‐Carbohydrate Nutrition Supplement on Postoperative Outcomes in Elderly Patients Receiving Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Implications of Postpancreatectomy Hypophosphatemia

Oral Hydration Before and After Hip Replacement: The Notion Behind Every Action

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