Sodium Abnormalities Are an Independent Predictor of Complications in Total Joint Arthroplasty: A Cautionary Tale!

Wester, Christopher; Zhang, Theodore; Harrington, Melvyn A.; Halawi, Mohamad J.

doi:10.1016/j.arth.2021.08.006

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…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: 99%

“…H yponatremia is a relatively common occurrence following TJA and can have an adverse impact on a patient's postoperative course 5,6,9,10,14,18 . Several studies have shown that postoperative hyponatremia may lead to greater hospital LOS, higher readmission rates, and greater health-care costs 10,15,18 . Despite this recognition, relatively few studies in the arthroplasty literature have investigated the influence of hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, other studies have reported that hyponatremia leads to increased LOS and readmission rates, which consequently increase health-care costs 10,15 . Nevertheless, relatively few studies have evaluated the impact of hyponatremia in orthopaedic sur-gery 6,10,[16][17][18] . Even fewer studies have investigated the association between the preoperative-to-postoperative change in sodium level and perioperative outcomes 9 .…”

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

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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Improved outcomes with perioperative dietitian-led interventions in patients undergoing total joint arthroplasty: A systematic review

Yee,

Schmidt,

Satalich

et al. 2024

Journal of Orthopaedics

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Epidemiology and Outcomes of Hypernatraemia in Patients with COVID-19—A Territory-Wide Study in Hong Kong

Wong

Chan

et al. 2023

JCM

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Background: Dysnatraemias are commonly reported in COVID-19. However, the clinical epidemiology of hypernatraemia and its impact on clinical outcomes in relation to different variants of SARS-CoV-2, especially the prevailing Omicron variant, remain unclear. Methods: This was a territory-wide retrospective study to investigate the clinical epidemiology and outcomes of COVID-19 patients with hypernatraemia at presentation during the period from 1 January 2020 to 31 March 2022. The primary outcome was 30-day mortality. Key secondary outcomes included rates of hospitalization and ICU admission, and costs of hospitalization. Results: In this study, 53,415 adult COVID-19 patients were included for analysis. Hypernatraemia was observed in 2688 (5.0%) patients at presentation, of which most cases (99.2%) occurred during the local “5th wave” dominated by the Omicron BA.2 variant. Risk factors for hypernatraemia at presentation included age, institutionalization, congestive heart failure, dementia, higher SARS-CoV-2 Ct value, white cell count, C-reactive protein and lower eGFR and albumin levels (p < 0.001 for all). Patients with hypernatraemia showed significantly higher 30-day mortality (32.0% vs. 5.7%, p < 0.001) and longer lengths of stay (12.9 ± 10.9 vs. 11.5 ± 12.1 days, p < 0.001) compared with those with normonatraemia. Multivariate analysis revealed hypernatraemia at presentation as an independent predictor for 30-day mortality (aHR 1.32, 95% CI 1.14–1.53, p < 0.001) and prolonged hospital stays (OR 1.55, 95% CI 1.17–2.05, p = 0.002). Conclusions: Hypernatraemia is common among COVID-19 patients, especially among institutionalized older adults with cognitive impairment and other comorbidities during large-scale outbreaks during the Omicron era. Hypernatraemia is associated with unfavourable outcomes and increased healthcare utilization.

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Sodium Abnormalities Are an Independent Predictor of Complications in Total Joint Arthroplasty: A Cautionary Tale!

Cited by 4 publications

References 19 publications

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty

Improved outcomes with perioperative dietitian-led interventions in patients undergoing total joint arthroplasty: A systematic review

Epidemiology and Outcomes of Hypernatraemia in Patients with COVID-19—A Territory-Wide Study in Hong Kong

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