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Preoperative Dehydration Is an Underrecognized Modifiable Risk Factor in Total Hip Arthroplasty.

Brandon E Lung¹, Matthew Kim², Kylie Callan¹

¹UC Irvine Department of Orthopaedic Surgery, Orange, California.

Journal of Surgical Orthopaedic Advances

|May 30, 2024

Summary

Optimizing preoperative dehydration in total hip arthroplasty (THA) patients significantly reduces complications and costs. Identifying dehydration using blood urea nitrogen to creatinine ratio (BUN/Cr) aids in better patient outcomes.

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Area of Science:

Orthopedic Surgery
Patient Safety
Preoperative Optimization

Background:

Dehydration is a modifiable risk factor impacting total hip arthroplasty (THA) outcomes.
Preoperative dehydration can lead to increased postoperative complications and healthcare costs.
Current clinical practice may overlook dehydration as a significant risk factor.

Purpose of the Study:

To investigate the association between preoperative dehydration status and postoperative outcomes in THA patients.
To determine if dehydration is a predictor of complications, prolonged length of stay, and discharge disposition after THA.
To evaluate the utility of the BUN/Cr ratio as a diagnostic tool for preoperative dehydration.

Main Methods:

Retrospective analysis of 212,452 primary THA cases from the National Surgical Quality Improvement Program database (2005-2019).
Patients classified into nondehydrated (<20), moderately dehydrated (20-25), and severely dehydrated (>25) based on BUN/Cr ratio.
Subgroup analysis conducted on elderly patients (>65 years) using normalized gender-adjusted Cr values.

Main Results:

Severely dehydrated patients showed significantly higher risks of overall complications, transfusion-requiring anemia, nonhome discharge, and extended length of stay (p < 0.01).
Elderly dehydrated patients faced increased risks of postoperative transfusion, cardiac complications, and nonhome discharge (p < 0.01).
A BUN/Cr ratio > 20 identified at-risk dehydrated patients.

Conclusions:

Preoperative dehydration is a critical, modifiable risk factor in THA.
Optimizing hydration status can mitigate postoperative complications and reduce inpatient costs.
The BUN/Cr ratio serves as a valuable preoperative tool for identifying and managing dehydration in THA candidates.