Hyponatremia associated with increased length of stay, complications after TJA
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Key takeaways:
- Patients with hyponatremia are at increased risk for poor outcomes after TJA.
- Surgeons should make efforts to address hyponatremia in the preoperative period.
Results published in the Journal of Bone and Joint Surgery found patients with hyponatremia, a common electrolyte abnormality, are at risk for increased length of stay, complications and nonhome discharge after total joint arthroplasty.
Colin M. Baker, DO, MBA, and colleagues from the Rothman Orthopaedic Institute at Thomas Jefferson University performed a retrospective study of 3,071 patients (mean age of 66.8 years) who underwent primary or revision, unilateral or bilateral total hip and total knee arthroplasties from 2015 to 2017. Patients were placed into four groups based on their preoperative to postoperative sodium levels: group 1 consisted of patients who were normonatremic to normonatremic (84.6%); group 2 consisted of patients who were normonatremic to hyponatremic (9.4%); group 3 consisted of patients who were hyponatremic to normonatremic (2.1%); and group 4 consisted of patients who were hyponatremic to hyponatremic (3.8%).
Outcome measures included length of stay (LOS), postoperative discharge and 90-day readmissions and complications, according to the study. Baker and colleagues found risk factors for postoperative hyponatremia included older age, THA, general anesthesia, increased Charlson Comorbidity Index, congestive heart failure, revision surgery, and history of stroke, liver disease or chronic kidney disease.
Researchers found that compared with patients who were normonatremic throughout, patients who were hyponatremic preoperatively or postoperatively had a greater risk for an increased LOS, a complication by 90 days and a nonhome discharge after TJA.
“Patients with both preoperative and postoperative hyponatremia were particularly at risk,” the researchers wrote in the study. “Efforts should be made to evaluate and, if possible, address hyponatremia in the preoperative period,” they concluded.
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