Factors associated with postoperative acute kidney injury after hip fractures in elderly patients

Kang, Joon Soon; Moon, Kyoung Ho; Youn, Yung Hun; Park, Joon Seong; Ko, Sang-Hyun; Jeon, Young-Chan

doi:10.1177/2309499019896237

Cited by 26 publications

(28 citation statements)

References 19 publications

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“…Although the pre-surgery hemoglobin level was similar in both groups, the hemoglobin loss was more significant in the IR group. Previous studies have shown that perioperative blood loss is associated with lower mobility during physiotherapy ( 26 ), an increased risk for major adverse cardiovascular events ( 27 ), acute kidney injury ( 28 ), a longer hospital stay, and a higher rate of rehospitalization ( 29 ). Impaired kidney function tests, which were more common in the IR group, have a strong association with functional status in the future ( 30 , 31 ), a greater risk of major adverse cardiovascular events ( 27 ), and even increased mortality ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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Background: As the population ages, the rate of hip fractures and the need for rehabilitation increases. Home-based rehabilitation (HBR) is an alternative to classic inpatient rehabilitation (IR), which is an expensive framework with non-negligible risks. Methods: A retrospective study of patients 65 years and above following surgery to repair a hip fracture who underwent HBR or IR between 2016 and 2019. The two rehabilitation frameworks were compared for rehabilitation outcome and factors predicting successful rehabilitation. The outcome was determined with the Montebello Rehabilitation Factor Score-Revised (MRFS-R). Results: Data were collected for 235 patients over 3 years. The mean age was 81.3 ± 8.0 and 172 (73.3%) were women. Of these, 138 underwent IR and 97 HBR. The HBR group had better family support and fewer lived alone. There were also differences in the type of fracture and surgery. The medical condition of the IR group was more complex, as reflected in a higher Charlson's comorbidity scores, higher rates for delirium and more infectious complications, a lower Norton score, lower serum hemoglobin, and albumin levels, and higher serum creatinine and urea levels. It also had a more significant functional decline after surgery and required a longer rehabilitation period. However, no difference was found in the rehabilitation outcomes between the two groups (MRFS-R ≥ 50). The independent predictors for rehabilitation in the IR group were serum albumin level, comorbidity, and cognitive state. There were no independent predictors in the HBR group. Conclusions: In this retrospective study, there was no significant difference in short-term rehabilitation outcomes between the HBR and IR groups event though the patients in the IR group were medically more complex. This result should be taken into account when planning rehabilitation services after hip fracture and tailoring rehabilitation frameworks to patients.

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Section: Discussionmentioning

confidence: 99%

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

et al. 2020

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“…After removing duplicated and irrelative items, the full texts of 57 remaining articles were screened for possible eligibility. Eventually, a total of 11 studies with 16,421 patients was included in the current meta-analysis [3,6,8,[16][17][18][19][20][21][22][23]. The flow chart of study selection was summarized in Figure 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis

Wang

et al. 2021

Bioengineered

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Acute kidney injury (AKI) was a frequent complication following hip fracture surgery, but recent studies reported inconsistent findings. Our study was aimed at clarifying the prevalence and risk factors of AKI after hip fracture surgery. Pubmed, Embase, and Web of Science were systematically searched from the inception to March 2020 to identify observational studies investigating the prevalence and risk factors of AKI in patients undergoing hip fracture surgery. Pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Publication bias was evaluated with a funnel plot and statistical test. All the statistical analyses were performed using Stata version 12.0. A total of 11 studies with 16,421 patients was included in the current meta-analysis. The pooled prevalence of AKI in patients undergoing hip fracture surgery was 17% (95%CI, 14%-21%) with substantial heterogeneity (I 2 = 95%). Postoperative serum albumin (OR 1.80; 95%CI, 1.38-2.36) was a significant predictor for AKI. Age (OR 1.01; 95%CI, 0.95-1.07) and ACE inhibitors (OR 1.38; 95%CI, 0.92-2.07) were associated with increased the risk of AKI, but the results were not statistically significant. No significant publication bias was identified through statistical tests (Egger's test, p = 0.258 and Begg's test, p = 0.087). In conclusion, our findings indicated that the pooled AKI following hip fracture surgery was approximately 17%. Postoperative serum albumin was a potential significant risk factor for AKI.

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“…13,17,18 However, given that the clinical importance of a perioperative decrease in serum albumin levels or early postoperative hypoalbuminaemia on postoperative morbidities has been emphasized, it is important to concentrate on perioperative or early postoperative changes in serum albumin levels and their relationship with postoperative outcomes. [19][20][21][22][23][24] Several reports demonstrated the relationship between perioperative changes in serum albumin and the development of postoperative pneumonia in patients with gastric, colorectal, and lung cancers. 19,21,22,24 However, scant studies investigated the risk factors of postoperative pneumonia in patients undergoing hip fracture surgery, and the relationship between early postoperative hypoalbuminaemia and postoperative pneumonia has never been delineated.…”

Section: Introductionmentioning

confidence: 99%

<p>Early Postoperative Hypoalbuminaemia as a Risk Factor for Postoperative Pneumonia Following Hip Fracture Surgery</p>

Shin

Kim

Son

et al. 2020

CIA

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Purpose: Postoperative pneumonia is a common and devastating complication of hip fracture surgery in older individuals. This study aimed to determine the relationship between early postoperative hypoalbuminaemia and pneumonia after hip fracture surgery. Patients and Methods: In this retrospective cohort study conducted at one centre, we reviewed the medical records of 1155 consecutive patients (>60 years) who underwent hip fracture surgery. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative pneumonia. After determining the cutoff value for postoperative serum albumin, the patients were divided into two groups according to the minimum serum albumin level recorded during the first two postoperative days: group A included patients with a minimum serum album level less than 3.0 g/dL and group B included patients with a minimum serum album level of at least 3.0 g/dL. The prevalence of postoperative pneumonia was analysed using inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) analyses. Results: The incidence of postoperative pneumonia following hip fracture surgery was 5.1% (n=59). Age, cardiovascular disease, and early postoperative hypoalbuminaemia during the first two postoperative days were independent risk factors for postoperative pneumonia. Early postoperative hypoalbuminaemia was associated with postoperative pneumonia development in the PSM and IPTW analyses (P = 0.016 and <0.001, respectively). Conclusion: This study demonstrated that early postoperative hypoalbuminaemia is an independent risk factor for the development of postoperative pneumonia in patients undergoing hip fracture surgery.

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Factors associated with postoperative acute kidney injury after hip fractures in elderly patients

Cited by 26 publications

References 19 publications

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

Intensive Inpatient vs. Home-Based Rehabilitation After Hip Fracture in the Elderly Population

The prevalence and risk factors of acute kidney injury in patients undergoing hip fracture surgery: a meta-analysis

<p>Early Postoperative Hypoalbuminaemia as a Risk Factor for Postoperative Pneumonia Following Hip Fracture Surgery</p>

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