Brandon E. Lung, MD; Matthew Kim, BA; Kylie Callan, BS; Maddison McLellan, BA; Edward D. Wang, MD; William McMaster, MD; Steven Yang, MD; and David H. So, MD
Preoperative Dehydration Is an Underrecognized Modiļ¬able Risk Factor in Total Hip Arthroplasty
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Dehydration is an overlooked modiļ¬able risk factor that should be optimized prior to elective total hip arthroplasty (THA) to reduce postoperative complications and inpatient costs. All primary THA from 2005 ā 2019 were queried from the National Surgical Quality Improvement Program database, and patients were compared based on dehydration status: blood urea nitrogen (BUN): creatinine ratio (Cr) (BUN/Cr) < 20 (nondehydrated), 20 ā¤ BUN/Cr ā¤ 25 (moderately dehydrated), 25 < BUN/ Cr (severely dehydrated). A subgroup analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed. The analysis included 212,452 patients who underwent THA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of overall complications, postoperative anemia requiring transfusion, nonhome discharge, and increased length of stay (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of postoperative transfusion, cardiac complications, and nonhome discharge (all p < 0.01). BUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. (Journal of Surgical Orthopaedic Advances 33(1):017-025, 2024)
Key words: hip arthroplasty, postoperative complications, dehydration status, BUN/Cr ratio, ACS NSQIP