Sanada Masato, Tominaga Hiroyuki, Kawamura Ichiro, Tokumoto Hiroto, Ogura Takuma, Taniguchi Noboru
Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan.
Spine Surg Relat Res. 2023 Dec 27;8(3):267-271. doi: 10.22603/ssrr.2023-0158. eCollection 2024 May 27.
The incidence of hyponatremia after orthopedic surgery is high. Hyponatremia may prolong hospitalization and increase mortality, but few reports have identified risk factors for hyponatremia after spinal surgery. This study aims to determine the incidence and risk factors for hyponatremia after spinal surgery.
A total of 200 patients aged 20 years or older who underwent spinal surgery at our hospital from 2020-2021 were recruited. Data on age, sex, height, weight, body mass index, operation duration, blood loss, albumin level, the geriatric nutritional risk index (GNRI), potassium level, the estimated glomerular filtration rate (eGFR), sodium level, length of hospital stay, history of hypertension, dialysis status, the occurrence of delirium during hospital stay, and oral medication use were collected. Comparisons between the postoperative hyponatremia group and the postoperative normonatremia group were conducted to evaluate the impact of hyponatremia on clinical outcomes.
Postoperative hyponatremia was observed in 56 (28%) of the 200 patients after spinal surgery. Comparison between the postoperative hyponatremia group with the postoperative normonatremia group revealed that the patients in the postoperative hyponatremia group were significantly older (72 versus 68.5 years, p<0.01). Postoperative hyponatremia was significantly associated with low GNRI values (100.8 versus 109.3, p<0.01), low eGFR values (59.2 versus 70.8 mL/min/1.73 m, p<0.01), preoperative hyponatremia (138.5 vs. 141 mEq/L, p<0.01), and a high incidence of delirium (12.5% versus 2.7%, p=0.01). Older age (odds ratio=1.04, p=0.01) and preoperative hyponatremia (odds ratio=0.66, p value<0.01) were risk factors for postoperative hyponatremia.
In addition to older age and preoperative hyponatremia, the study identified new risk factors for postoperative hyponatremia, which are preoperative undernutrition and impaired renal function. The incidence of delirium was significantly higher in the postoperative hyponatremia group, suggesting that correcting preoperative hyponatremia and ensuring good nutrition may prevent delirium and thereby shorten hospital stays.
骨科手术后低钠血症的发生率很高。低钠血症可能会延长住院时间并增加死亡率，但很少有报告确定脊柱手术后低钠血症的危险因素。本研究旨在确定脊柱手术后低钠血症的发生率及危险因素。
选取2020年至2021年在我院接受脊柱手术的200例年龄≥20岁的患者。收集患者的年龄、性别、身高、体重、体重指数、手术时长、失血量、白蛋白水平、老年营养风险指数（GNRI）、血钾水平、估算肾小球滤过率（eGFR）、血钠水平、住院时间、高血压病史、透析状态、住院期间谵妄的发生情况以及口服药物使用情况。对术后低钠血症组和术后血钠正常组进行比较，以评估低钠血症对临床结局的影响。
200例脊柱手术后患者中，56例（28%）出现术后低钠血症。术后低钠血症组与术后血钠正常组比较显示，术后低钠血症组患者年龄显著更大（72岁对68.5岁，p<0.01）。术后低钠血症与低GNRI值（100.8对109.3，p<0.01）、低eGFR值（59.2对70.8 mL/min/1.73 m²，p<0.01）、术前低钠血症（138.5对141 mEq/L，p<0.01）及谵妄高发生率（12.5%对2.7%，p=0.01）显著相关。年龄较大（比值比=1.04，p=0.01）和术前低钠血症（比值比=0.66，p值<0.01）是术后低钠血症的危险因素。
除年龄较大和术前低钠血症外，本研究还确定了术后低钠血症的新危险因素，即术前营养不良和肾功能受损。术后低钠血症组谵妄发生率显著更高，提示纠正术前低钠血症并确保良好营养状况可能预防谵妄，从而缩短住院时间。
