Preoperative hyponatremia and perioperative complications

Alexander A. Leung, Finlay A. McAlister, Selwyn O. Rogers, Valeria Pazo, Adam Wright, David W. Bates

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain. Methods: To determine whether preoperative hyponatremia is a predictor of 30-day perioperative morbidity and mortality, we conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify 964 263 adults undergoing major surgery from more than 200 hospitals (from January 1, 2005, to December 31, 2010) and observed them for 30-day perioperative outcomes. We used multivariable logistic regression to estimate relative risks for death, major coronary events, wound infections, and pneumonia occurring within 30 days of surgery and quantile regression to estimate differences in average length of hospital stay. Results: A total of 75 423 patients with preoperative hyponatremia (sodium level <135 mEq/L [to convert to millimoles per liter, multiply by 1.0]) were compared with 888 840 patients with normal baseline sodium levels (135-144 mEq/L). Preoperative hyponatremia was associated with a higher risk of 30-day mortality (5.2% vs 1.3%; adjusted odds ratio [aOR], 1.44; 95% CI, 1.38-1.50), and this finding was consistent in all the subgroups. This association was particularly marked in patients undergoing nonemergency surgery (aOR, 1.59; 95% CI, 1.50-1.69; P<001 for interaction) and American Society of Anesthesiologists class 1 and 2 patients (aOR, 1.93; 95% CI, 1.57-2.36; P<001 for interaction). Furthermore, hyponatremiawas associated with a greater risk of perioperative major coronary events (1.8% vs 0.7%; aOR, 1.21; 95% CI, 1.14-1.29), wound infections (7.4% vs 4.6%; 1.24; 1.20-1.28), and pneumonia (3.7% vs 1.5%; 1.17; 1.12-1.22) and prolonged median lengths of stay by approximately 1 day. Conclusion: Preoperative hyponatremia is a prognostic marker for perioperative 30-day morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)1474-1481
Number of pages8
JournalArchives of Internal Medicine
Volume172
Issue number19
DOIs
StatePublished - Oct 22 2012
Externally publishedYes

Fingerprint

Hyponatremia
Odds Ratio
Length of Stay
Mortality
Wound Infection
Morbidity
Pneumonia
Sodium
Quality Improvement
Ambulatory Surgical Procedures
Cohort Studies
Logistic Models
Databases

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Leung, A. A., McAlister, F. A., Rogers, S. O., Pazo, V., Wright, A., & Bates, D. W. (2012). Preoperative hyponatremia and perioperative complications. Archives of Internal Medicine, 172(19), 1474-1481. https://doi.org/10.1001/archinternmed.2012.3992

Preoperative hyponatremia and perioperative complications. / Leung, Alexander A.; McAlister, Finlay A.; Rogers, Selwyn O.; Pazo, Valeria; Wright, Adam; Bates, David W.

In: Archives of Internal Medicine, Vol. 172, No. 19, 22.10.2012, p. 1474-1481.

Research output: Contribution to journalArticle

Leung, AA, McAlister, FA, Rogers, SO, Pazo, V, Wright, A & Bates, DW 2012, 'Preoperative hyponatremia and perioperative complications', Archives of Internal Medicine, vol. 172, no. 19, pp. 1474-1481. https://doi.org/10.1001/archinternmed.2012.3992
Leung AA, McAlister FA, Rogers SO, Pazo V, Wright A, Bates DW. Preoperative hyponatremia and perioperative complications. Archives of Internal Medicine. 2012 Oct 22;172(19):1474-1481. https://doi.org/10.1001/archinternmed.2012.3992
Leung, Alexander A. ; McAlister, Finlay A. ; Rogers, Selwyn O. ; Pazo, Valeria ; Wright, Adam ; Bates, David W. / Preoperative hyponatremia and perioperative complications. In: Archives of Internal Medicine. 2012 ; Vol. 172, No. 19. pp. 1474-1481.
@article{be02b44cee664d30b0d5e6de4de3f594,
title = "Preoperative hyponatremia and perioperative complications",
abstract = "Background: Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain. Methods: To determine whether preoperative hyponatremia is a predictor of 30-day perioperative morbidity and mortality, we conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify 964 263 adults undergoing major surgery from more than 200 hospitals (from January 1, 2005, to December 31, 2010) and observed them for 30-day perioperative outcomes. We used multivariable logistic regression to estimate relative risks for death, major coronary events, wound infections, and pneumonia occurring within 30 days of surgery and quantile regression to estimate differences in average length of hospital stay. Results: A total of 75 423 patients with preoperative hyponatremia (sodium level <135 mEq/L [to convert to millimoles per liter, multiply by 1.0]) were compared with 888 840 patients with normal baseline sodium levels (135-144 mEq/L). Preoperative hyponatremia was associated with a higher risk of 30-day mortality (5.2{\%} vs 1.3{\%}; adjusted odds ratio [aOR], 1.44; 95{\%} CI, 1.38-1.50), and this finding was consistent in all the subgroups. This association was particularly marked in patients undergoing nonemergency surgery (aOR, 1.59; 95{\%} CI, 1.50-1.69; P<001 for interaction) and American Society of Anesthesiologists class 1 and 2 patients (aOR, 1.93; 95{\%} CI, 1.57-2.36; P<001 for interaction). Furthermore, hyponatremiawas associated with a greater risk of perioperative major coronary events (1.8{\%} vs 0.7{\%}; aOR, 1.21; 95{\%} CI, 1.14-1.29), wound infections (7.4{\%} vs 4.6{\%}; 1.24; 1.20-1.28), and pneumonia (3.7{\%} vs 1.5{\%}; 1.17; 1.12-1.22) and prolonged median lengths of stay by approximately 1 day. Conclusion: Preoperative hyponatremia is a prognostic marker for perioperative 30-day morbidity and mortality.",
author = "Leung, {Alexander A.} and McAlister, {Finlay A.} and Rogers, {Selwyn O.} and Valeria Pazo and Adam Wright and Bates, {David W.}",
year = "2012",
month = "10",
day = "22",
doi = "10.1001/archinternmed.2012.3992",
language = "English (US)",
volume = "172",
pages = "1474--1481",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "19",

}

TY - JOUR

T1 - Preoperative hyponatremia and perioperative complications

AU - Leung, Alexander A.

AU - McAlister, Finlay A.

AU - Rogers, Selwyn O.

AU - Pazo, Valeria

AU - Wright, Adam

AU - Bates, David W.

PY - 2012/10/22

Y1 - 2012/10/22

N2 - Background: Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain. Methods: To determine whether preoperative hyponatremia is a predictor of 30-day perioperative morbidity and mortality, we conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify 964 263 adults undergoing major surgery from more than 200 hospitals (from January 1, 2005, to December 31, 2010) and observed them for 30-day perioperative outcomes. We used multivariable logistic regression to estimate relative risks for death, major coronary events, wound infections, and pneumonia occurring within 30 days of surgery and quantile regression to estimate differences in average length of hospital stay. Results: A total of 75 423 patients with preoperative hyponatremia (sodium level <135 mEq/L [to convert to millimoles per liter, multiply by 1.0]) were compared with 888 840 patients with normal baseline sodium levels (135-144 mEq/L). Preoperative hyponatremia was associated with a higher risk of 30-day mortality (5.2% vs 1.3%; adjusted odds ratio [aOR], 1.44; 95% CI, 1.38-1.50), and this finding was consistent in all the subgroups. This association was particularly marked in patients undergoing nonemergency surgery (aOR, 1.59; 95% CI, 1.50-1.69; P<001 for interaction) and American Society of Anesthesiologists class 1 and 2 patients (aOR, 1.93; 95% CI, 1.57-2.36; P<001 for interaction). Furthermore, hyponatremiawas associated with a greater risk of perioperative major coronary events (1.8% vs 0.7%; aOR, 1.21; 95% CI, 1.14-1.29), wound infections (7.4% vs 4.6%; 1.24; 1.20-1.28), and pneumonia (3.7% vs 1.5%; 1.17; 1.12-1.22) and prolonged median lengths of stay by approximately 1 day. Conclusion: Preoperative hyponatremia is a prognostic marker for perioperative 30-day morbidity and mortality.

AB - Background: Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain. Methods: To determine whether preoperative hyponatremia is a predictor of 30-day perioperative morbidity and mortality, we conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify 964 263 adults undergoing major surgery from more than 200 hospitals (from January 1, 2005, to December 31, 2010) and observed them for 30-day perioperative outcomes. We used multivariable logistic regression to estimate relative risks for death, major coronary events, wound infections, and pneumonia occurring within 30 days of surgery and quantile regression to estimate differences in average length of hospital stay. Results: A total of 75 423 patients with preoperative hyponatremia (sodium level <135 mEq/L [to convert to millimoles per liter, multiply by 1.0]) were compared with 888 840 patients with normal baseline sodium levels (135-144 mEq/L). Preoperative hyponatremia was associated with a higher risk of 30-day mortality (5.2% vs 1.3%; adjusted odds ratio [aOR], 1.44; 95% CI, 1.38-1.50), and this finding was consistent in all the subgroups. This association was particularly marked in patients undergoing nonemergency surgery (aOR, 1.59; 95% CI, 1.50-1.69; P<001 for interaction) and American Society of Anesthesiologists class 1 and 2 patients (aOR, 1.93; 95% CI, 1.57-2.36; P<001 for interaction). Furthermore, hyponatremiawas associated with a greater risk of perioperative major coronary events (1.8% vs 0.7%; aOR, 1.21; 95% CI, 1.14-1.29), wound infections (7.4% vs 4.6%; 1.24; 1.20-1.28), and pneumonia (3.7% vs 1.5%; 1.17; 1.12-1.22) and prolonged median lengths of stay by approximately 1 day. Conclusion: Preoperative hyponatremia is a prognostic marker for perioperative 30-day morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=84868266998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868266998&partnerID=8YFLogxK

U2 - 10.1001/archinternmed.2012.3992

DO - 10.1001/archinternmed.2012.3992

M3 - Article

VL - 172

SP - 1474

EP - 1481

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 19

ER -