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Predictors and outcome impact of perioperative serum sodium changes in a high-risk population.


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Authors

Klinck, J 
McNeill, L 
Di Angelantonio, Emanuele  ORCID logo  https://orcid.org/0000-0001-8776-6719
Menon, DK 

Abstract

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 7 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 >5 mmol litre(-1). RESULTS: Changes in sodium concentration >5 mmol litre(-1) were associated with increased mortality risk (adjusted odds ratio 1.49 for a decrease, 3.02 for an increase). Factors independently associated with a perioperative decrease in serum sodium concentration >5 mmol litre(-1) included age >60, diabetes mellitus, and the 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 haemorrhage. 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.

Description

Keywords

hospital mortality, perioperative period, sodium, Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Obesity, Perioperative Period, Retrospective Studies, Sodium, Surgical Procedures, Operative

Journal Title

Br J Anaesth

Conference Name

Journal ISSN

0007-0912
1471-6771

Volume Title

114

Publisher

Elsevier BV
Sponsorship
Medical Research Council (G0001354)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
This work was supported by the Cambridge University Division of Anaesthesia.