Preoperative Hyponatremia is a Risk Factor for Adverse 30-Day Outcomes Following Total Hip Arthroplasty

Abstract

The relationship between preoperative hyponatremia and 30-day outcomes following total hip arthroplasty (THA) is currently unknown. The present study used prospectively collected data to quantify the association between preoperative hyponatremia and odds of major morbidity (MM), longer length of stay, readmission, and reoperation within 30 days following THA. Patients who underwent THA between 2012 and 2014 were identified in the National Surgical Quality Improvement Program database using validated Current Procedural Terminology codes. Patients were included if they were either normonatremic or hyponatremic preoperatively. The outcome measures in this study were 30-day MM, hospital length of stay, 30-day readmission, and 30-day reoperation. A unique multivariable logistic regression model was used for each outcome to identify statistically significant associations between hyponatremia and the outcome of interest after adjusting for covariates. From 2012 to 2014, 59,236 THA procedures were recorded in National Surgical Quality Improvement Program, of which 55,611 patients were normonatremic and 3,051 patients were hyponatremic. After adjusting for covariates, preoperative hyponatremia was significantly associated with increased odds of MM (odds ratio [OR] = 1.14; 99% confidence interval [CI]: 1.01–1.30), 30-day reoperation (OR = 1.18; 99% CI: 1.02–1.36), and longer hospital length of stay (OR = 1.20; 99% CI: 1.13–1.27). Hyponatremia was not significantly associated with greater odds of 30-day readmission (OR = 0.91; 99% CI: 0.82–1.01). Preoperative hyponatremia was significantly associated with adverse 30-day outcomes following THA. As the U.S. health care system continues to transition toward value-based reimbursement that emphasizes health care quality, the results of the present study can be used to improve patient selection and preoperative counseling.

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

“…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 . Importantly, no previous studies evaluated the relationship of both preoperative and postoperative hyponatremia with clinical outcomes following TJA.…”

“…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 . 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 .…”

What are the risk factors associated with limited musculoskeletal health literacy in shoulder arthroplasty patients?

“…Multivariable logistic regression analysis was used to evaluate predictors of inadequate musculoskeletal literacy, alongside multiple imputation modeling with predictive mean matching to account for missing responses. Multiple imputation has been utilized in many previous studies as an effective means of accounting for missing not at random data (Chan et al., 2017; Hamilton et al., 2010; Tanenbaum et al., 2020). Sex, ethnicity, timing of surgery, education, income, smoking status, prior orthopaedic visits, and prior research on their condition/procedure were evaluated using dummy variables, with adequacy of LiMP score as the dependent variable.…”