Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery

Chan, Helen Yue Lai; Cheng, Anthony; Cheung, Susana S S; Pang, Wai-Wah; Ma, Wai-Yiu; Mok, Long-Chau; Wong, Wai-Kuen; Lee, Diana

doi:10.1111/jocn.14336

Cited by 24 publications

(23 citation statements)

References 27 publications

(89 reference statements)

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“…We found dehydrated patients to have a mean LOS almost twice as long as nondehydrated patients, although our multivariate analysis did not identify any significant association between LOS and dehydration. None of the complications we examined were found to be significantly associated with dehydration, which is in contrast to previous reports in the surgical literature that showed dehydration to be significantly correlated with respiratory, gastrointestinal, and hematologic complications 8 …”

Section: Discussioncontrasting

confidence: 99%

“…However, on multivariate regression analysis, age between 61 and 80 years was found to be significantly associated with dehydration, although this finding had low precision with a wide CI. Currently, there is discrepancy in the surgical literature as to which comorbidities are associated with preoperative dehydration in surgical patients 8,9 . This study showed dependent functional status to be a significant determinant of hydration status only on univariate analysis, and not in the multivariate model, suggesting the presence of confounding factors associated with both dehydration and functional status.…”

Section: Discussioncontrasting

confidence: 54%

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Impact of preoperative dehydration on endoscopic transsphenoidal pituitary surgery

Joseph

Barinsky

Kim

et al. 2021

Int Forum Allergy Rhinol

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 54%

Impact of preoperative dehydration on endoscopic transsphenoidal pituitary surgery

Joseph

Barinsky

Kim

et al. 2021

Int Forum Allergy Rhinol

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“…These conclusions were not supported by our findings. Chan et al ., after examining the records of 216 patients, concluded that patients who had preoperative dehydration status were more likely to experience hematologic or gastrointestinal postoperative complications which is consistent with our finding of increased need for blood transfusion in both THA and TKA patients who were dehydrated prior to surgery [ 12 ]. The main difference between our study and the studies previously mentioned is that previous studies examined orthopedic surgeries more broadly, rather than patients specifically undergoing elective THA and TKA.…”

Section: Discussionsupporting

confidence: 78%

“…Another widely adopted metric for assessing hydration status is the Blood Urea Nitrogen (BUN)/Creatinine (Cr) ratio. In the literature, thresholds for the dehydrated state range from a ratio greater than 15 to a ratio greater than 25, but the threshold is most commonly set at a ratio greater than 20 [ 12 , 13 ]. However, the relationship between preoperative hydration status and postoperative complications in total joint arthroplasty is largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

Does dehydration prior to primary total joint arthroplasty increase risk of perioperative complications?

et al. 2021

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Background Prior studies have suggested that preoperative dehydration increases odds of perioperative complications in several areas of orthopedic surgery. This study aimed to evaluate whether preoperative hydration status is associated with the incidence of short-term complications after primary total joint arthroplasty. Methods The 2012–2019 National Surgical Quality Improvement Program (NSQIP) database was used to explore the relationship between preoperative dehydration (ratio of preoperative BUN divided by preoperative Creatinine (BUN/Creatinine) > 20) and perioperative outcomes of total hip (THA) and total knee arthroplasty (TKA) patients. Univariate comparisons and multivariate regression analyses were conducted to identify specific complications that occurred more often in patients with preoperative dehydration. Results Of 188,629 THA and 332,485 TKA patients, 46.3 and 47.0% had preoperative dehydration, respectively. After controlling for demographics and comorbidities, dehydrated THA patients were no more likely to experience a complication compared to their non-dehydrated counterparts (relative risk [RR] = 0.97, 99.7% Confidence Interval [CI]: 0.92–1.03, P = 0.138) nor increased risk of blood transfusion (RR = 1.02, CI = 0.96–1.08, P = 0.408). Similar to THA patients, dehydrated TKA patients were not more likely to have a complication after surgery (RR = 0.97, CI = 0.92–1.03, P = 0.138) and were at no greater risk of transfusion (RR = 1.02, CI = 0.96–1.07, P = 0.408). A sub-analysis covering only patients with BUN and Cr values determined within 24 h after surgery was performed and similarly found no significant increase in perioperative complications or transfusion. Conclusion Overall, preoperative dehydration in patients undergoing THA/TKA did not appear to increase risk of transfusion or other perioperative complications. Further research is needed to characterize the role of hydration prior to elective total joint arthroplasty.

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“…Hyperosmotic dehydration traditionally refers to a total body water deficit often induced by a combination of restricted fluid intake and exposure to adverse environments . Fluid volume depletion is associated with poorer health outcomes when concomitant with chronic diseases, increased mortality among elderly and intensive care patients, decreased physical and cognitive performance, and impaired postoperative recovery …”

Section: Introductionmentioning

confidence: 99%

Dehydration assessment via a portable, single sided magnetic resonance sensor

Bashyam

Frangieh

et al. 2019

Magnetic Resonance in Med

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Undiagnosed dehydration compromises health outcomes across many populations. Existing dehydration diagnostics require invasive bodily fluid sampling or are easily confounded by fluid and electrolyte intake, environment, and physical activity limiting widespread adoption. We present a portable MR sensor designed to measure intramuscular fluid shifts to identify volume depletion. Methods: Fluid loss is induced via a mouse model of thermal dehydration (37°C; 15-20% relative humidity). We demonstrate quantification of fluid loss induced by hyperosmotic dehydration with multicomponent T2 relaxometry using both a benchtop NMR system and MRI localized to skeletal muscle tissue. We then describe a miniaturized (~1000 cm 3) portable (~4 kg) MR sensor (0.28 T) designed to identify dehydration-induced fluid loss. T2 relaxometry measurements were performed using a Carr-Purcell-Meiboom-Gill pulse sequence in ~4 min. Results: T2 values from the portable MR sensor exhibited strong (R 2 = 0.996) agreement with benchtop NMR spectrometer. Thermal dehydration induced weight loss of 4 to 11% over 5 to 10 h. Fluid loss induced by thermal dehydration was accurately identified via whole-animal NMR and skeletal muscle. The portable MR sensor accurately identified dehydration via multicomponent T2 relaxometry. Conclusion: Performing multicomponent T2 relaxometry localized to the skeletal muscle with a miniaturized MR sensor provides a noninvasive, physiologically relevant measure of dehydration induced fluid loss in a mouse model. This approach offers sensor portability, reduced system complexity, fully automated operation, and low cost compared with MRI. This approach may serve as a versatile and portable point of care technique for dehydration monitoring.

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Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery

Abstract: Given its significant influence on care outcomes and postoperative recovery, hydration care that promotes early recognition and timely management of dehydration is an integral part of fundamental care for older persons.

Cited by 24 publications

References 27 publications

Impact of preoperative dehydration on endoscopic transsphenoidal pituitary surgery

Impact of preoperative dehydration on endoscopic transsphenoidal pituitary surgery

Does dehydration prior to primary total joint arthroplasty increase risk of perioperative complications?

Dehydration assessment via a portable, single sided magnetic resonance sensor

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