Preoperative Hyponatremia and Perioperative Complications in Cervical Spinal Fusion

Pennington, Zach; Bomberger, Thomas T.; Lubelski, Daniel; Benzel, Edward C.; Steinmetz, Michael P.; Mroz, Thomas E.

doi:10.1016/j.wneu.2020.06.068

Cited by 5 publications

(8 citation statements)

References 38 publications

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“…We defined major complications as a composite outcome measure comprising the following 9 morbidities: surgical site infection, wound dehiscence, pulmonary complications, unplanned reintubation, renal complications, neurological complications, cardiac complications, deep venous thromboembolism, and sepsis. In line with previous large-scale clinical studies in the American College of Surgeons National Surgical Quality Improvement Program, this definition ensures the comprehensive inclusion of clinically relevant outcomes ( 38 , 42 ). We excluded all measures of mortality in this composite measure because we conducted a separate analysis for mortality outcomes.…”

Section: Resultsmentioning

confidence: 89%

“…Twelve studies included patients who underwent orthopedic surgeries ( 16 , 18 , 24 , 27 , 32 , 33 , 35 , 38 , 41-43 , 45 ); 10 studies involved patients who underwent liver transplantation ( 5 , 7 , 26 , 29 , 31 , 36 , 39 , 40 , 46 , 48 ); 4 studies for cardiac surgical procedures ( 17 , 28 , 37 , 44 ); 3 studies on surgeries of multiple disciplines ( 9 , 14 , 30 ); and 1 study each on radical gastrectomy ( 47 ), surgical procedures for epithelial ovarian cancer ( 34 ), and radical surgical procedures for pancreatic ductal adenocarcinoma ( 25 ). Sixteen studies included patients from North America ( 5 , 7 , 14 , 16-18 , 27 , 28 , 30 , 32 , 35 , 37-39 , 42 , 43 ), 8 studies from Europe ( 9 , 25 , 29 , 34 , 36 , 40 , 41 , 45 ), 5 from Asia ( 31 , 33 , 46-48 ), 2 from South America ( 24 , 26 ), and 1 from Israel ( …”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies included early mortality ( 5 , 7 , 9 , 14 , 16 , 24 , 26 , 28 , 29 , 32 , 33 , 36 , 37 , 39-42 , 44 ) and 9 studies included late mortality ( 7 , 24 , 28 , 29 , 36 , 37 , 39 , 44 , 48 ) as part of mortality outcomes. Sixteen studies included at least 1 outcome that qualified as a major complication ( 7 , 14 , 18 , 24 , 28-32 , 36-38 , 40 , 42-44 ), 4 reported on respiratory complications ( 7 , 14 , 28 , 32 ), 6 on cardiac complications ( 14 , 24 , 30 , 32 , 37 , 44 ), 10 on renal complications ( 7 , 28-32 , 36 , 37 , 40 , 44 ), 7 on neurological complications ( 7 , 14 , 24 , 28 , 31 , 40 , 44 ), and 5 on postoperative sepsis ( 7 , 24 , 29 ,…”

Section: Resultsmentioning

confidence: 99%

“…We defined early mortality as postoperative mortality at first time point of measurement reported in the study, with duration of <90 days. Twelve studies defined early mortality as 30-day all-cause mortality (death occurring within 30 days of surgical procedures regardless of cause, in or out of the hospital, including intraoperative and postoperative deaths) ( 7 , 9 , 14 , 16 , 24 , 28 , 32 , 36 , 39 , 41 , 42 , 44 ). Four studies used 90-day all-cause mortality as outcome ( 5 , 26 , 29 , 40 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regarding outcomes of use of hospital resources, 9 studies reported on length of hospitalization ( 18 , 27 , 28 , 30 , 32 , 37 , 38 , 42 , 43 ), 2 on non-home discharge ( 35 , 38 ), 6 on 30-day readmission ( 18 , 24 , 32 , 38 , 42 , 43 ), and 4 on 30-day reoperation ( 18 , 38 , 42 , 43 ).…”

Section: Resultsmentioning

confidence: 99%

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Association of Preoperative Hyponatremia With Surgical Outcomes: A Systematic Review and Meta-analysis of 32 Observational Studies

Teo

Gan

Tay

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Background Preoperative hyponatremia is prevalent in patients undergoing surgical procedures, but it is uncertain if hyponatremia will lead to increased risk of surgical mortality and morbidity. Methods A systematic search of Medline (PubMed), Embase and Cochrane Library from inception till 2 July 2021 was performed. Full length articles that reported on the association between surgical outcomes among adults ≥18 years with documented preoperative hyponatremia were included. Findings We identified 32 observational studies comprising 1,301,346 participants. All studies had low risk of bias. When adjusted for covariates, patients with hyponatremia had significantly higher odds of developing major complications (defined as a composite measure of 9 major complications) compared to patients with normal sodium concentrations (aOR = 1.37, 95%CI = 1.23-1.53, I2 = 78%. N = 10). Additionally, patients with preoperative hyponatremia also significantly higher hazards of early mortality (<90 days) compared to patients with normonatremia (aHR = 1.27, 95%CI = 1.13-1.43, I2 = 97%. N = 10) after adjustment for covariates. Preoperative hyponatremia also had significant associations with respiratory, renal and septic complications. In terms of prognostic performance, preoperative hyponatremia performed adequately in predicting major complications in surgical patients (AUC = 0.70, LR- 0.90) with a specificity of 88% and a sensitivity of 25%. Interpretation Our meta-analysis suggests that preoperative hyponatremia is associated with poorer early mortality and major morbidity outcomes in surgical patients. Hyponatremia is also a specific prognosticator for major complications in surgical patients, reiterating its potential use as a clinical indicator of poor outcomes.

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Association of Preoperative Hyponatremia With Surgical Outcomes: A Systematic Review and Meta-analysis of 32 Observational Studies

Teo

Gan

Tay

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Postoperative Hyponatremia in the Orthopaedic Patient

Ruggles,

Metikala,

Satpathy

et al. 2024

Unusual Conditions That Every Orthopaedic Surgeon Should Know

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Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy

Liu,

Hu,

et al. 2023

BMC Neurol

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Background Limited data exist regarding preoperative serum sodium (Na) and 30-day mortality in adult patients with tumor craniotomy. Therefore, this study investigates their relationship. Methods A secondary retrospective analysis was performed using data from the ACS NSQIP database (2012–2015). The principal exposure was preoperative Na. The outcome measure was 30-day postoperative mortality. Binary logistic regression modeling was conducted to explore the link between them, and a generalized additive model and smooth curve fitting were applied to evaluate the potential association and its explicit curve shape. We also conducted sensitivity analyses and subgroup analyses. Results A total of 17,844 patients (47.59% male) were included in our analysis. The mean preoperative Na was 138.63 ± 3.23 mmol/L. The 30-day mortality was 2.54% (455/17,844). After adjusting for covariates, we found that preoperative Na was negative associated with 30-day mortality. (OR = 0.967, 95% CI:0.941, 0.994). For patients with Na ≤ 140, each increase Na was related to a 7.1% decreased 30-day mortality (OR = 0.929, 95% CI:0.898, 0.961); for cases with Na > 140, each increased Na unit was related to a 8.8% increase 30-day mortality (OR = 1.088, 95% CI:1.019, 1.162). The sensitivity analysis and subgroup analysis indicated that the results were robust. Conclusions This study shows a positive and nonlinear association between preoperative Na and postoperative 30-day mortality in adult patients with tumor craniotomy. Appropriate preoperative Na management and maintenance of serum Na near the inflection point (140) may reduce 30-day mortality.

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Preoperative Hyponatremia and Perioperative Complications in Cervical Spinal Fusion

Cited by 5 publications

References 38 publications

Association of Preoperative Hyponatremia With Surgical Outcomes: A Systematic Review and Meta-analysis of 32 Observational Studies

Association of Preoperative Hyponatremia With Surgical Outcomes: A Systematic Review and Meta-analysis of 32 Observational Studies

Postoperative Hyponatremia in the Orthopaedic Patient

Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy

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