Predictors and outcome impact of perioperative serum sodium changes in a high risk population
Di, Angelantonio E
British Journal of Anaesthesia
Oxford Journals on behalf of the British Journal of Anaesthesia
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Klinck, J., McNeill, L., Di, A. E., & Menon, D. (2014). Predictors and outcome impact of perioperative serum sodium changes in a high risk population. British Journal of Anaesthesia, 114 615-622. https://doi.org/10.1093/bja/aeu409
BACKGROUND: The perioperative period may be associated with a marked neurohumoral stress response, significant fluid losses and varied fluid replacement regimes. Acute changes in serum sodium concentration are therefore common, but predictors and outcomes of these changes have not been investigated in a large surgical population. METHODS: We carried out a retrospective cohort analysis of 27,068 in-patient non-cardiac surgical procedures in a tertiary teaching hospital setting. Data on preoperative conditions, perioperative events, hospital length of stay and mortality were collected, along with preoperative and postoperative serum sodium measurements up to seven days after surgery. Logistic regression was used to investigate the association between sodium changes and mortality, and to identify clinical characteristics associated with a deviation from baseline sodium greater than 5 mmol/l. RESULTS: Changes in sodium concentration > 5mmol/l were associated with increased mortality risk (adjusted OR 1.49 for a decrease, 3.02 for an increase). Factors independently associated with a perioperative decrease in serum sodium concentration >5 mmol/l included age >60, diabetes mellitus and use of patient-controlled opioid analgesia. Factors associated with a similar increase were preoperative oxygen dependency, mechanical ventilation, central nervous system depression, non-elective surgery and major operative hemorrhage. CONCLUSIONS: Maximum deviation from preoperative serum sodium value is associated with increased hospital mortality in patients undergoing in-patient non-cardiac surgery. Specific preoperative and perioperative factors are associated with significant serum sodium changes.
Hospital Mortality, Perioperative Period, Sodium
This work was supported by the Cambridge University Division of Anaesthesia.
MEDICAL RESEARCH COUNCIL (G0001354)
British Heart Foundation (RG/08/014/24067)
External DOI: https://doi.org/10.1093/bja/aeu409
This record's URL: https://www.repository.cam.ac.uk/handle/1810/246085