Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture

Abstract

Background: Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. Methods: We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). Results: The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. Conclusions: Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.

The prevalence of chronic dehydration and associated with cardiometabolic risks among agriculture and aquaculture workers

“…Dehydration was measured by plasma osmolarity and pOsm ≥295 or ≥ 300 (mOsm/kg) was classified as impending or hyperosmolar dehydration (21,26,27). For every participant, blood samples were gathered in the early morning, specifically between 7 and 8 am, prior to their breakfast, following a fasting period of at least 8 h. This fasting interval only permitted water intake.…”

“…Admission dehydration status may be a significant and independent predictor of short-term mortality in patients with spontaneous intracerebral hemorrhage (17-19). In addition, dehydration on admission is significantly associated with postoperative complication rates, in-hospital mortality, and length of hospital stay (20,21). Dehydration is common in hospitals and communities of older people (22)(23)(24)(25).…”

“…Recently, the direct measurement of plasma osmolarity (pOsm) has been recommended as a valuable marker for determining dehydration (24, 25). A pOsm >295 or > 300 mOsm/kg has been defined as impending or hyperosmolar dehydration (21,22,26,27). Osmolality indicates the concentration of all particles dissolved in body fluid (28, 29).…”

“…Chronic dehydration is primarily due to insufficient fluid intake over a lengthy period to replace obligatory fluid loss and is characterized by increased serum osmolality (24, 26). The risk factors for chronic dehydration include older age, long-term care residents, cognitive impairment, female, and use of diuretics (21,23,30). In the county of Yunlin, the proportion of older people (>65 years) ranks 3 rd among 22 counties in Taiwan with most people working in farms and fisheries; both occupations were more impacted by cardiometabolic diseases (31,32).…”

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

“…Especially since patients usually fast for 8 hours before surgery, which leads to dehydration [1]. Poor intraoperative fluid resuscitation can lead to poor patient outcomes [2].…”