Preoperative hypernatremia predicts increased perioperative morbidity and mortality

Area of Science:

• Perioperative Medicine
• Nephrology
• Surgical Outcomes Research

Background:

• The prognostic significance of preoperative hypernatremia remains largely uncharacterized.
• Understanding the impact of preoperative electrolyte imbalances on surgical outcomes is crucial for patient care.

Purpose of the Study:

• To investigate the association between preoperative hypernatremia and 30-day perioperative morbidity and mortality.
• To determine if preoperative hypernatremia serves as an independent predictor of adverse surgical outcomes.

Main Methods:

• A large cohort study utilizing the American College of Surgeons-National Surgical Quality Improvement Program database (2005-2010).
• Inclusion of 908,869 adult patients undergoing major surgery across approximately 300 hospitals.
• Analysis of 30-day outcomes including mortality, major coronary events, pneumonia, and venous thromboembolism using multivariable logistic regression.

Main Results:

• Preoperative hypernatremia (defined as >144 mmol/L) was identified in 2.2% of patients (20,029 individuals).
• Hypernatremia was significantly associated with increased 30-day mortality (5.2% vs 1.3%; aOR 1.44) and morbidity, including major coronary events, pneumonia, and venous thromboembolism.
• The risk of adverse outcomes escalated with increasing severity of preoperative hypernatremia.

Conclusions:

• Preoperative hypernatremia is a significant independent predictor of increased 30-day perioperative morbidity and mortality.
• These findings underscore the importance of monitoring and managing preoperative sodium levels in surgical patients.