Can patients with mild post-operative hyponatraemia following elective arthroplasty be discharged safely? A large-scale service evaluation suggests they can

Macdonald, Jonathan; Cunningham, Emma; Gallagher, Nicola; Hamilton, Paul; Cassidy, Roslyn; Bryce, Leeann; Beverland, David

doi:10.1177/00045632211051526

Cited by 3 publications

(5 citation statements)

References 25 publications

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“…Four of those studies utilized large registry databases that, despite including larger cohorts, most likely had inherent biases because hyponatremia was identified using ICD codes as opposed to the actual laboratory measurements 18-20,25 . The remaining studies had smaller cohorts 4,5,7,9,10,16,17,24,26 , with the largest having a cohort of 2,009 patients, similar to our study 24 . Furthermore, several of those studies solely investigated the association between preoperative hyponatremia and perioperative outcomes 19,20,25 .…”

Section: Discussionsupporting

confidence: 80%

“…This was consistent for both primary and revision TJA. While Macdonald et al found that postoperative hyponatremia was not independently associated with increased LOS or 90-day readmission 24 , multiple studies have found hyponatremia to adversely affect perioperative outcomes 5,10,17,18 .…”

Section: Discussionmentioning

confidence: 97%

“…A few prior studies have examined perioperative hyponatremia and its association with clinical outcomes following TJA 4,5,7,9,10,[16][17][18][19][20][24][25][26] . Four of those studies utilized large registry databases that, despite including larger cohorts, most likely had inherent biases because hyponatremia was identified using ICD codes as opposed to the actual laboratory measurements [18][19][20]25 .…”

Section: Discussionmentioning

confidence: 99%

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Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Baker

Goh

Tarabichi

et al. 2023

Journal of Bone and Joint Surgery

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Background:Hyponatremia is a common electrolyte abnormality in arthroplasty patients. This issue, underrecognized by surgeons, can impact the postoperative course of patients. There are, however, little data on the implications of sodium disturbances following total joint arthroplasty (TJA). The primary aims of this study were to (1) report the rate of hyponatremia following TJA, and (2) examine the impact of hyponatremia on the perioperative course of TJA patients.Methods:This was a retrospective analysis of 3,071 primary and revision TJAs performed between 2015 and 2017. Based on preoperative and postoperative sodium values (pre-post), patients were classified into 4 groups: normonatremic-normonatremic (Group 1), normonatremic-hyponatremic (Group 2), hyponatremic-normonatremic (Group 3), and hyponatremic-hyponatremic (Group 4). Primary end points were length of stay (LOS), postoperative discharge, in-hospital complications, and 90-day readmissions.Results:The distribution of cases was 84.6% Group 1, 9.4% Group 2, 2.1% Group 3, and 3.8% Group 4. Overall, 13.2% of patients had hyponatremia after TJA. Older age, hip arthroplasty, general anesthesia, higher Charlson Comorbidity Index, congestive heart failure, revision surgery, and history of stroke, liver disease, and chronic kidney disease were risk factors for postoperative hyponatremia. Patients with postoperative hyponatremia (Groups 2 and 4) had greater likelihoods of having a 90-day complication and non-home discharge and greater LOS.Conclusions:Postoperative hyponatremia was a relatively common occurrence in patients undergoing TJA, and was associated with greater LOS, complications, and non-home discharge. Surgeons should identify patients at risk for developing sodium abnormalities in order to optimize these patients and avoid increased resource utilization.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Baker

Goh

Tarabichi

et al. 2023

Journal of Bone and Joint Surgery

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“…Studies have shown that, although scarcely reported, hyponatraemia is as common as 20% in TJR patients. 41 Macdonald et al 42 believe that postoperative hyponatraemia is common and rarely warrants clinical intervention, as long as the patient is clinically well. It is our usual practice to discontinue routine intravenous fluids at the end of surgery.…”

Section: Discussionmentioning

confidence: 99%

The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement

Orfanos,

Nantha Kumar,

Redfern

et al. 2023

Bone Jt Open

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AimsWe aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI).MethodsThis is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported.ResultsThe study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI.ConclusionThe costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.Cite this article: Bone Jt Open 2023;4(11):899–905.

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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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Can patients with mild post-operative hyponatraemia following elective arthroplasty be discharged safely? A large-scale service evaluation suggests they can

Cited by 3 publications

References 25 publications

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement

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

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