Postoperative Hyponatremia in the Oncologic Orthopedic Patient: Incidence, Risk factors, and Outcomes

Zhu KY, Tollinche LE, Seier K, McCormick PJ, Mehta M, Yang G, Tan KS, Singh M and Cindy B

Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, USA Department of Anesthesiology, Metrohealth Medical Center of Case Western Reserve University School of Medicine, USA Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, USA School of Medicine, Case Western Reserve University, USA

^*Correspondance to: Kevin Y Zhu 

 PDF  Full Text DOI: 10.25107/2474-1647.3692

Abstract

Background: The purpose of this study is to determine the incidence of hyponatremia (serum [Na+] <133 mEq/L) among cancer patients undergoing surgical procedures and characterize associated risk factors and outcomes. Methods: This retrospective cohort analysis included adult surgical patients with a minimum of two hours of anesthesia time and post-surgical serum sodium level within 30 days in 2019. Univariable and multivariable logistic regression models were used to investigate associations between hyponatremia and 30-day all-cause mortality and Length of Stay (LOS). A subgroup analysis examined hip vs. knee procedures for orthopaedic oncology patients. Results: 24,137 patients were included in our study; of which 1,445 patients had orthopaedic surgery. Postoperative hyponatremia was noted in 15% of orthopedic patients and 13.5% of other surgical patients. Postoperative hyponatremia (OR=2.58 [95% Confidence Interval (CI), 2.01–3.30], p<0.001) and orthopedic surgery (1.85 ([1.28-2.66], p=0.001) were independently associated with higher 30-day mortality. It was also associated with longer LOS [7.0 vs. 4.0; p<0.001]. Multivariable analysis showed a 32% increase in LOS for hyponatremia patients ([1.30-1.35], p<0.001) and 20% increase for the orthopaedic patients ([1.16-1.23], p<0.001). Subgroup analysis of orthopaedic procedures revealed a higher prevalence of postoperative hyponatremia in hip compared to knee procedures (21.5% vs. 11.4%, p=0.042). Multivariable analysis demonstrated a 27% increase in LOS among hyponatremic patients ([1.13-1.43], p<0.001). Conclusion: Postoperative hyponatremia is associated with longer hospital stay and higher mortality in surgical oncology patients, and especially in orthopaedic procedures.

Keywords

Hyponatremia; Orthopedics; Oncology; Cancer; Outcomes; Postoperative

Cite the article

Zhu KY, Tollinche LE, Seier K, McCormick PJ, Mehta M, Yang G, et al. Postoperative Hyponatremia in the Oncologic Orthopedic Patient: Incidence, Risk factors, and Outcomes. Clin Surg. 2024; 9: 3692..